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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]

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]

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: 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]

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]

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]

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]

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]

The National Heart, Lung, and Blood Institute (NHLBI) Learn About Chronic Obstructive Pulmonary Disease (COPD) YouTube playlist educates the public on diagnosing, treating, and managing COPD. Despite its potential benefits, it is unknown if users with inadequate health literacy will likely understand and apply the information described in these videos. Assess the Learn About COPD playlist's readability, actionability, and understandability. Central tendency statistics were computed to describe the meta-data of 28 videos available as of April 2023. Assessments included the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV), Accessible Health IT for Limited-Literacy Populations Checklist (LLPC), and the Modified Centers for Disease Control and Prevention (CDC)-Clear Communication Index (CCI) for audiovisual materials. Playlist videos received an average of over 2,000 views (Mdn = 2,220, IQR = 496–8336), with very few "likes" (Mdn = 13, IQR = 1–48 "likes"). PEMAT-understandability (Mdn = 81.81%, IQR = 80–97.72%) and LLPC (Mdn = 87.50%, IQR = 75–93.75%) scores were high (above 80%). However, the modified CDC-CCI median score was 57.14% (IQR = 42.86–75%), and the median PEMAT-actionability score was 50% (IQR = 0–66.67%). The playlist earned passing understandability, acceptability, and usability scores but scored poorly on actionability and communication clarity. Findings could inform enhancements to NHLBI's Learn About COPD YouTube playlist. [ABSTRACT FROM AUTHOR]

Background The capability of large language models (LLMs) to understand and generate human-readable text has prompted the investigation of their potential as educational and management tools for patients with cancer and healthcare providers. Materials and Methods We conducted a cross-sectional study aimed at evaluating the ability of ChatGPT-4, ChatGPT-3.5, and Google Bard to answer questions related to 4 domains of immuno-oncology (Mechanisms, Indications, Toxicities, and Prognosis). We generated 60 open-ended questions (15 for each section). Questions were manually submitted to LLMs, and responses were collected on June 30, 2023. Two reviewers evaluated the answers independently. Results ChatGPT-4 and ChatGPT-3.5 answered all questions, whereas Google Bard answered only 53.3% (P  < .0001). The number of questions with reproducible answers was higher for ChatGPT-4 (95%) and ChatGPT3.5 (88.3%) than for Google Bard (50%) (P  < .0001). In terms of accuracy, the number of answers deemed fully correct were 75.4%, 58.5%, and 43.8% for ChatGPT-4, ChatGPT-3.5, and Google Bard, respectively (P  = .03). Furthermore, the number of responses deemed highly relevant was 71.9%, 77.4%, and 43.8% for ChatGPT-4, ChatGPT-3.5, and Google Bard, respectively (P  = .04). Regarding readability, the number of highly readable was higher for ChatGPT-4 and ChatGPT-3.5 (98.1%) and (100%) compared to Google Bard (87.5%) (P  = .02). Conclusion ChatGPT-4 and ChatGPT-3.5 are potentially powerful tools in immuno-oncology, whereas Google Bard demonstrated relatively poorer performance. However, the risk of inaccuracy or incompleteness in the responses was evident in all 3 LLMs, highlighting the importance of expert-driven verification of the outputs returned by these technologies. [ABSTRACT FROM AUTHOR]

Stroke education materials are crucial for the recovery of stroke patients, but their effectiveness depends on their readability. The American Medical Association (AMA) recommends patient education materials be written at a sixth-grade level. Studies show existing paper and online materials exceed patients' reading levels and undermine their health literacy. Low health literacy among stroke patients is associated with worse health outcomes and decreased efficacy of stroke rehabilitation. We reviewed the readability of paper (i.e brochures, factsheets, posters) and online (i.e American Stroke Association, Google, Yahoo!) stroke patient education materials, reading level of stroke patients, accessibility of online health information, patients' perceptions on gaps in stroke information, and provided recommendations for improving readability. A PRISMA-guided systematic literature review was conducted using PUBMED, Google Scholar, and EbscoHost databases and "stroke", "readability of stroke patient education", and "stroke readability" search terms to discover English-language articles. A total of 12 articles were reviewed. SMOG scores for paper and online material ranged from 11.0 - 12.0 grade level and 7.8 - 13.95 grade level respectively. Reading level of stroke patients ranged from 3rd grade to 9th grade level or above. Accessibility of online stroke information was high. Structured patient interviews illustrated gaps in patient education materials and difficulty with comprehension. Paper and online patient education materials exceed the reading level of stroke patients and the AMA recommended 6th grade level. Due to limitations in readability, stroke patients are not being adequately educated about their condition. [ABSTRACT FROM AUTHOR]

Background: Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods: We usedChatGPTversions 3.5 and4.0 tomodify 27 questions and answers fromDonate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results: Originally, the FAQs had an average reading level of 9.6 ± 1.9. Postmodification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30±1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion: Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible. [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 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]

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]

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]

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]

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]

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]

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]

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]

Purpose: The purposes of this clinical focus article are to describe differences in expressive prosody among autistic individuals, describe the role of prosody in reading comprehension, highlight the potential contribution of prosody to the reading comprehension difficulties experienced by many autistic individuals, discuss interventions that target prosody, and make clinical recommendations. Method: We describe differences in expressive prosody that many autistic individuals experience; review the existing body of literature surrounding reading comprehension, prosody, and autism; and discuss interventions that target prosody as it applies to reading comprehension. Conclusion: Based on the review of the literature and presentation of the challenges that currently exist, we make clinical recommendations regarding the integration of interventions addressing prosody in expressive communication and reading comprehension for autistic individuals who have strong word reading skills and poor reading comprehension. [ABSTRACT FROM AUTHOR]

People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n  = 10), text-based materials (n  = 5), films (n  = 8) and radio (n  = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the content, reliability, quality and readability of information on Internet websites about early orthodontic treatment. Methods: The "early orthodontic treatment" search term was individually entered into four web search engines. The content quality and reliability were reviewed with DISCERN, Journal of American Medical Association (JAMA), and Health on the Net code (HONcode) tools using the contents of websites meeting predetermined criteria. The readability of websites was evaluated with Flesch Reading Facilitate Score (FRES) and Flesch–Kincaid Grade Level (FKGL). Results: Eighty-six websites were suitable for inclusion and scoring of the 200 websites. 80.2% of websites belonged to orthodontists, 15.1% to multidisciplinary dental clinics and 4.7% to professional organizations. The mean DISCERN score of all websites (parts 1 and 2) was 27.98/75, ranging between 19 and 67. Professional organization websites had the highest scores for DISCERN criteria. Moreover, 45.3% of websites were compatible with JAMA's disclosure criterion, 7% with the currency criterion, 5.8% with the authorship criterion and 5.8% with the attribution criterion. Only three websites met all JAMA criteria, and these websites belonged to professional organizations. None of the websites had the HONcode logo. Mean FRES and FKGL were 47.6 and 11.6, respectively. Conclusions: The quality of web-based information about early orthodontic treatment is poor, and readability is insufficient. More accurate and higher quality Internet sources are required on the web. [ABSTRACT FROM AUTHOR]

Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impede patients' comprehension. This study investigates the use of GPT-4 to simplify surgical consent forms and introduces an AI-human expert collaborative approach to validate content appropriateness. Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review. Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review. This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Our framework could be extended to other patient communication materials, emphasizing clear communication and mitigating disparities related to health literacy barriers. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the readability and quality of torticollis-related web content. Methods: The top 3 browsers were determined. The 2 reviewers structured their websites according to type. Each one's quality was determined based on whether or not it conformed to the Health On the Net (HON) code as well as using some scoring tools such as the DISCERN score, Journal of American Medical Association (JAMA) benchmark, and Global Quality score (GQS). To evaluate readability, the Flesch-Kincaid grade level (FKGL) was applied. Results: Sixty websites were identified. The categories were as follows: 12 (20%) academic, 26 (43.3%) medical, 13 (21.7%) physician, and 9 (15%) commercial. The DISCERN, JAMA, GQS, FKGL, and Torticollis-Specific Content (TSC) scores of the academic category were significantly higher than those of the other categories. Websites with a HON code had considerably higher DISCERN, JAMA, GQS, and TSC scores than those without it (p<0.05). Conclusion: Most material on the websites reviewed in this study was of low quality. Despite the higher quality of academic resources, the material was challenging to comprehend. The current study can aid in the evaluation of information that may be important for preserving equilibrium in patient-doctor relationships. [ABSTRACT FROM AUTHOR]

Purpose: While the National Institutes of Health and American Medical Association recommend patient education materials (PEMs) should be written at the sixth‐grade reading level or below, many patient education materials related to traumatic orthopaedic injuries do not meet these recommendations. The purpose of this study is to create a standardised method for enhancing the readability of trauma‐related orthopaedic PEMs by reducing the use of ≥ three syllable words and reducing the use of sentences >15 words in length. We hypothesise that applying this standardized method will significantly improve the objective readability of orthopaedic trauma PEMs. Methods: A patient education website was queried for PEMs relevant to traumatic orthopaedic injuries. Orthopaedic trauma PEMs included (N = 40) were unique, written in a prose format, and <3500 words. PEM statistics, including scores for seven independent readability formulae, were determined for each PEM before and after applying this standard method. Results: All PEMs had significantly different readability scores when comparing original and edited PEMs (p < 0.01). The mean Flesch Kincaid Grade Level of the original PEMs (10.0 ± 1.0) was significantly higher than that of edited PEMs (5.8 ± 1.1) (p < 0.01). None of the original PEMs met recommendations of a sixth‐grade reading level compared with 31 (77.5%) of edited PEMs. Conclusions: This standard method that reduces the use of ≥ three syllable words and <15 word sentences has been shown to significantly reduce the reading‐grade level of PEMs for traumatic orthopaedic injuries. Improving the readability of PEMs may lead to enhanced health literacy and improved health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Orthopaedic Patient Education Materials (PEMs) related to total hip and total knee arthroplasty (TKA) have repeatedly been shown to not meet American Medical Association and National Institutes of Health recommendations for readability. PEMs that are written with too much complexity limit the ability of some readers to comprehend the material. These complex PEMs also limit the health literacy of patients, a key determinant of health status and outcomes. The purpose of this study was to improve the readability of total hip and TKA‐related PEMs by limiting the use of sentences with ≥15 words and limiting the use of words with ≥ three syllables. Methods: The readability of all 26 PEMs in this study was assessed before and after editing. Editing of articles included limiting the use of sentences with ≥15 words and limiting the use of words with ≥three syllables while preserving PEM content. Results: A total of 26 PEMs were available for use in this study after the application of inclusion and exclusion criteria. The percentage of original PEMs at or below the recommended sixth‐grade reading level was 0% (0 out of 26), while the percentage of edited PEMs at or below the sixth‐grade reading level was 50% (13 out of 26). Conclusions: Using this standardised method for reducing sentence length to <15 words and limiting the use of words with >2 syllables, while preserving key content, significantly improved the readability of PEMs related to total hip and TKA. [ABSTRACT FROM AUTHOR]

Background: Telerehabilitation is an easy and creative approach to rehabilitation treatments for osteoarthritis. In telerehabilitation, there are various modes through which exercises can be explained to the patients. Videos and brochures are commonly used to send patients exercise plans. Videos are easy to understand and can mimic live demonstrations and brochures are easy to create and customise for every patient's need. The present study aimed to evaluate the effectiveness of brochure and video methods of exercise prescription through telerehabilitation in terms of exercise acquisition and retention. Methods: The study design was a randomised clinical trial. A total of 110 knee osteoarthritis patients who agreed to participate in the telerehabilitation programme were recruited for the study. The patients were randomly assigned to a video and brochure group. After the initial consultation through videoconferencing, the prescribed exercises were sent on their phone in the form of video or electronic brochure. The participants were again contacted through video conferencing after 2 days and retention and acquisition tests were recorded. Results: The comparison of both groups through 't' test showed no significant difference in exercise retention and acquisition. The mean and SD of exercise acquisition in the brochure group was 26.3455, ±5.7998 and in the video group was 27.2, ±5.47181 and mean and SD of exercise retention in the brochure group was 7.8727, ±2.31784 and in the video group was 7.6, ±1.256. Further analysis revealed that the hamstring stretching exercise was retained better in the video group than in the brochure group (p = 0.031*). Conclusion: The study found no significant difference in exercise acquisition and retention between the video and brochure groups. Hence, an exercise brochure can be equally effective as a video for exercise prescription if the brochure is developed by keeping in mind the principles of readability and the use of proper instructions. [ABSTRACT FROM AUTHOR]

Introduction: Patients search on the Internet for information about various medical procedures and conditions. The main aim of this study was to evaluate the readability of online health information related to atopic dermatitis (AD). Online resources are becoming a standard in facilitating shared decision-making processes. With a pipeline of new therapeutic options like immunomodulators, understanding of the complexity of AD by the patients is crucial. Methods: The term "atopic dermatitis" translated into 23 official European Union languages was searched using the Google search engine. The first 50 records in each language were evaluated for suitability. Included materials were barrier-free, focused on patient education, and were not categorized as advertisements. Article sources were classified into four categories: non-profit, online shops, pharmaceutical companies, and dermatology clinic. Readability was assessed with Lix score. Results: A total of 615 articles in Swedish, Spanish, Slovenian, Slovak, Romanian, Portuguese, Polish, Lithuanian, Latvian, Irish, Italian, Hungarian, Greek, German, French, Finnish, Estonian, English, Dutch, Danish, Czech, Croatian, and Bulgarian were evaluated. The overall mean Lix score was 56 ± 8, which classified articles as very hard to comprehend. Significant differences in mean Lix scores were observed across all included languages (all P < 0.001). Articles released by non-profit organizations and pharmaceutical companies had the highest readability (P < 0.001). Low readability level was correlated with high article prevalence (R2 = 0.189, P = 0.031). Conclusions: Although there was an abundance of online articles related to AD, the readability of the available information was low. As online health information has become essential in making shared decisions between patients and physicians, an improvement in AD-related materials is needed. [ABSTRACT FROM AUTHOR]

Patient information materials often tend to be written at a reading level that is too advanced for patients. In this proof-of-concept study, we used ChatGPT and Google Bard to reduce the reading level of three selected patient information sections from scientific journals. ChatGPT successfully improved readability. However, it could not achieve the recommended 6th-grade reading level. Bard reached the reading level of 6th graders but oversimplified the texts by omitting up to 83% of the content. Despite the present limitations, developers of patient information are encouraged to employ large language models, preferably ChatGPT, to optimize their materials. [ABSTRACT FROM AUTHOR]

Aims The use of statin therapy is deemed to be controversial by mainstream media. Patients increasingly source medical information from the internet, and the use of statins is no exception. This study aims to determine the quality and educational content of statin-focused information on the internet and YouTube. Methods and results 'Statin' was searched on Google, Yahoo!, Bing, and YouTube. The first 50 results obtained from each search engine and the first 20 YouTube videos were screened by two assessors. Websites were assessed using the Flesch Reading Ease (FRE) score, University of Michigan Consumer Health Website Evaluation Checklist, and a customized scoring system evaluating statin-focused content for quality. Videos were scored using the Journal of the American Medical Association (JAMA) benchmark criteria, Global Quality Score (GQS), and the customized scoring system. Websites scored a median FRE score of 57.5 [interquartile range (IQR) 52.1–62.3], median Michigan score of 36 (IQR 32–41.5), and median content score of 5 (IQR 3.75–7). Good interobserver agreement was demonstrated [Michigan score interobserver coefficient correlation (ICC) = 0.968; content score ICC = 0.944]. Videos scored a median JAMA score of 2, median GQS score of 2.5, and median content score of 2.5. Good interobserver agreement was demonstrated (JAMA ICC = 0.746; GQS ICC = 0.874; content score ICC = 0.946). Conclusion Quality and readability of statin-focused online information are poor. Healthcare professionals should be aware of the limitations of the current available sources and design online resources that are accurate and patient-friendly. [ABSTRACT FROM AUTHOR]

The objective of this paper is to present and make publicly available the NILC-Metrix, a computational system comprising 200 metrics proposed in studies on discourse, psycholinguistics, cognitive and computational linguistics, to assess textual complexity in Brazilian Portuguese (BP). The metrics are relevant for descriptive analysis and the creation of computational models and can be used to extract information from various linguistic levels of written and spoken language. The metrics were developed during the last 13 years, starting in the end of 2007, within the scope of the PorSimples project. Once the PorSimples finished, new metrics were added to the initial 48 metrics of the Coh-Metrix-Port tool. Coh-Metrix-Port adapted some metrics to BP from the Coh-Metrix tool that computes metrics related to cohesion and coherence of texts in English. Given the large number of metrics, we present them following an organisation similar to the metrics of Coh-Metrix v3.0 to facilitate comparisons made with metrics in Portuguese and English, in future studies using both tools. In this paper, we illustrate the potential of the NILC-Metrix by presenting three applications: (i) a descriptive analysis of the differences between children's film subtitles and texts written for Elementary School I (comprises classes from 1st to 5th grade) and II (Final Years) (comprises classes from 6th to 9th grade, in an age group that corresponds to the transition between childhood and adolescence); (ii) a new predictor of textual complexity for the corpus of original and simplified texts of the PorSimples project; (iii) a complexity prediction model for school grades, using transcripts of children's story narratives told by teenagers. For each application, we evaluate which groups of metrics are more discriminative, showing their contribution for each task. [ABSTRACT FROM AUTHOR]

We report on a school-based randomized control trial study comparing two morphological interventions with untaught controls: one focusing on direct instruction targeting print morphological decoding (direct decoding condition) and the other on inquiry-focused pedagogy using oral morphological analysis (inquiry-analysis condition). We identified 63 Grade 3 children with below-average morphological awareness following screening (from N = 163). This sub-sample showed average pseudoword decoding but poor language and word reading abilities. Following a 13-week supplemental intervention randomized within the 63 children, results showed a statistically significant main effect of intervention on standardized reading vocabulary measures at immediate post-test in the direct decoding condition. Pre-test morphological awareness moderated reading vocabulary effects for the untaught control group. Statistically significant moderation of growth in sentence comprehension at post- by pre-test morphological awareness was also evident in the inquiry-analysis condition. Universal screening for below-average morphological awareness followed by inquiry-based or direct instruction interventions focusing on the meaning dimensions of morphemes may be modestly efficacious for supporting reading vocabulary and sentence comprehension in such at risk learners, potentially aiding school-wide literacy improvement. [ABSTRACT FROM AUTHOR]

This study investigates the visual angle threshold value for the recognition of Chinese characters displayed on the optical head-mounted display. As optical head-mounted displays are becoming increasingly popular in various fields, character legibility has become an important topic for research. In this study, a legibility test was conducted by randomly displaying characters on the optical head-mounted display. The characteristics that were tested included the number of strokes, components and usage frequency rankings. The visual angle threshold value of each character was recorded and analysed. The results indicate that Chinese characters with more strokes, more components and lower usage frequency have a larger visual angle threshold value than characters with fewer strokes, fewer components and higher frequency. The number of strokes and usage frequency rankings were inputted into a regression model to predict the visual angle threshold value for character recognition (R2 = 0.72; Adj-R2 = 0.71). The regression analyses revealed that the foregoing inputs increased the visual angle threshold value. These findings provide a practical reference for the display of Chinese characters on optical head-mounted displays. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to assess the quality of large language model (LLM) chatbot versus physician‐generated responses to patient‐generated rheumatology questions. Methods: We conducted a single‐center cross‐sectional survey of rheumatology patients (n = 17) in Edmonton, Alberta, Canada. Patients evaluated LLM chatbot versus physician‐generated responses for comprehensiveness and readability, with four rheumatologists also evaluating accuracy by using a Likert scale from 1 to 10 (1 being poor, 10 being excellent). Results: Patients rated no significant difference between artificial intelligence (AI) and physician‐generated responses in comprehensiveness (mean 7.12 ± SD 0.99 vs 7.52 ± 1.16; P = 0.1962) or readability (7.90 ± 0.90 vs 7.80 ± 0.75; P = 0.5905). Rheumatologists rated AI responses significantly poorer than physician responses on comprehensiveness (AI 5.52 ± 2.13 vs physician 8.76 ± 1.07; P < 0.0001), readability (AI 7.85 ± 0.92 vs physician 8.75 ± 0.57; P = 0.0003), and accuracy (AI 6.48 ± 2.07 vs physician 9.08 ± 0.64; P < 0.0001). The proportion of preference to AI‐ versus physician‐generated responses by patients and physicians was 0.45 ± 0.18 and 0.15 ± 0.08, respectively (P = 0.0106). After learning that one answer for each question was AI generated, patients were able to correctly identify AI‐generated answers at a lower proportion compared to physicians (0.49 ± 0.26 vs 0.97 ± 0.04; P = 0.0183). The average word count of AI answers was 69.10 ± 25.35 words, as compared to 98.83 ± 34.58 words for physician‐generated responses (P = 0.0008). Conclusion: Rheumatology patients rated AI‐generated responses to patient questions similarly to physician‐generated responses in terms of comprehensiveness, readability, and overall preference. However, rheumatologists rated AI responses significantly poorer than physician‐generated responses, suggesting that LLM chatbot responses are inferior to physician responses, a difference that patients may not be aware of. [ABSTRACT FROM AUTHOR]

Identifying factors that associate with more cited or higher quality research may be useful to improve science or to support research evaluation. This article reviews evidence for the existence of such factors in article text and metadata. It also reviews studies attempting to estimate article quality or predict long‐term citation counts using statistical regression or machine learning for journal articles or conference papers. Although the primary focus is on document‐level evidence, the related task of estimating the average quality scores of entire departments from bibliometric information is also considered. The review lists a huge range of factors that associate with higher quality or more cited research in some contexts (fields, years, journals) but the strength and direction of association often depends on the set of papers examined, with little systematic pattern and rarely any cause‐and‐effect evidence. The strongest patterns found include the near universal usefulness of journal citation rates, author numbers, reference properties, and international collaboration in predicting (or associating with) higher citation counts, and the greater usefulness of citation‐related information for predicting article quality in the medical, health and physical sciences than in engineering, social sciences, arts, and humanities. [ABSTRACT FROM AUTHOR]

Saudi Arabia has the second-highest prevalence of diabetes in the Middle East. Therefore, providing patients with high-quality materials is essential to help them understand their illness. The Patient Education Materials Assessment Tool (PEMAT) contrasts and evaluates materials regarding understandability and actionability. This study aimed to evaluate materials for type 2 diabetes using a printed version of the PEMAT. This observational study was conducted in Riyadh from December 2022 to May 2023. Sixty-nine samples were collected from hospitals affiliated with the Ministry of Health and the government sector. Materials evaluated in this study had an excellent understandability score of 78.9% and a low actionability score of 66.6%, with significant differences between the sources. Some of the materials (42%) achieved high quality regarding understandability and actionability. Less than half of the materials were considered high quality. Approximately 99% of the materials made their purposes completely evident and logically presented the information, and approximately 97% identified at least one action. However, only 17.4% of the materials provided summaries and tangible tools. Health Educators should consider including summaries and tangible tools when developing patient education materials to make them more understandable and actionable. [ABSTRACT FROM AUTHOR]

There is concern that accounting standards are difficult to understand by those who use them. We investigate factors that enhance and inhibit the ability of the standards' users to comprehend their meaning and requirements. Readability statistics reveal that Australian accounting standards are difficult or very difficult to read. Interviews with experienced financial statement preparers and auditors from the for‐profit, not‐for‐profit private, and public sectors reveal that 'understandability' is a function of many inter‐related factors, only some of which relate to how standards are written and presented. We offer recommendations to standards‐setters about how the understandability of standards could be improved. [ABSTRACT FROM AUTHOR]

This study examined how linguistic complexity features contribute to second language (L2) processing effort by analyzing the Dutch English-L2 learners' eye movements from GECO and MECO, two eye-tracking corpora. Processing effort was operationalized as reading rate, mean fixation duration, regression rate, skipping rate, and mean saccade amplitude. In Study 1, the lexical, syntactic, and discoursal indices in 272 snippets of a novel in GECO were regressed against these eye-movement measures. The results showed that the one-component partial least square regression (PLS-R) models could explain 11%–37% of the variance in these eye-movement measures and outperformed eight readability formulas (six traditional and two recent cognitively inspired formulas based on the readers' perception on text difficulty) in predicting L2 processing effort. In Study 2, the eye-tracking data from MECO were used to evaluate whether the findings from Study 1 could be applied more broadly. The results revealed that although the predictability of these PLS-R components decreased, they still performed better than the readability formulas. These findings suggest that the linguistic indices identified can be used to predict L2 text processing effort and provide useful implications for developing systems to assess text difficulty for L2 learners. [ABSTRACT FROM AUTHOR]

HIV remains a significant public health issue among young adults living in Uganda. There is a need for reliable and valid measures of key psychological and behavioural constructs that are related to important outcomes for this population. We translated, adapted and tested the psychometric properties of questionnaires measuring HIV stigma, HIV disclosure cognitions and affect, antiretroviral therapy (ART) adherence, social support, personal values, and hope, using a multi-step process. This included: translation, back-translation, expert review, cognitive interviewing, readability and assessments of internal consistency with 93 young adults (18–25 years) living with perinatally acquired HIV in Uganda. Preliminary criterion validity was assessed by examining relationships between the adapted measures and wellbeing, HIV disclosure behaviour, HIV disclosure intention and viral load suppression. The measures all showed acceptable reliability and every questionnaire apart from the Agentic and Communal Value Scale was easy to read. Those scales measuring HIV disclosure affect and cognitions, social support, HIV stigma and hope showed relationships with other constructs suggestive of validity. There is preliminary evidence to support the use of these measures in research and clinical contexts for young adults living with perinatally acquired HIV in Uganda. [ABSTRACT FROM AUTHOR]

(1) Background: Because of their direct and continuous contact with the patient, nurses play a relevant role in ensuring that informed consent forms are complete and easy to read and comprehend. The objective of this study was to analyze the legibility and formal quality of informed consent forms for non-surgical procedures in a county hospital. (2) Methods: The readability of these forms was analyzed using the INFLESZ scale and the information they provided according to the formal quality criteria established for these forms. (3) Results: Readability was difficult in 78.08% of the forms analyzed. No form fulfilled all the criteria, the most non-compliant being the non-appearance of the verification of delivery of a copy to the patient (100%), the contraindications (94.59%), and the alternatives (83.78%) of the procedure. Statistically significant differences were observed between disciplines with respect to the INFLESZ readability score and the formal quality score, but no statistically significant correlation was found between the two scores. (4) Conclusions: The informed consent forms for non-surgical procedures analyzed presented mostly difficult readability and poor formal quality, making it difficult for patients to have understandable and complete information. Nursing professionals should be actively involved in their improvement to facilitate patient decision making. [ABSTRACT FROM AUTHOR]

Using debt crowdfunding data, we investigate whether borrowers' writing style is associated with an online lender and borrower behaviors, whether the information contained in linguistic style can mitigate information asymmetry in peer-to-peer markets, and whether online investors correctly interpret the economic value of written texts. Peer-to-peer lenders bid more aggressively, are more likely to fund, and charge lower rates to online borrowers whose writing is more readable, more positive, and contains fewer deception cues. Moreover, such borrowers are less likely to default. Online investors, however, fail to fully account for the information contained in borrowers' writing. [ABSTRACT FROM AUTHOR]

Background: Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers. Methods: A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact. Results: A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (β, 17.8, CI 13.94–21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81–12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10–0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (β -0.59, P = 0.012), as did engagement rate (β -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy. Conclusions: Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition. [ABSTRACT FROM AUTHOR]

Background: The internet has become a primary source of health information, particularly for cancer patients. This study evaluated the quality of online health information related to colon cancer in Arabic. Objective: To assess the reliability, accountability, legitimacy, and readability of Arabic websites providing information on colon cancer. Methods: A search was conducted on major search engines using Arabic keywords related to colon cancer. After initial screening, 13 websites were selected for evaluation. The Journal of the American Medical Association (JAMA) benchmarks, DISCERN instrument and website certification (Health on the Net - HON code) were used for assessment. Readability was analyzed using the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Results: Non-government websites, particularly Wikipedia, msdmanuals.com, and primomedico.com, demonstrated higher compliance with JAMA benchmarks. Six websites scored high on the DISCERN instrument, indicating reliable treatment information. Only one website was HON-code certified. Readability analysis revealed that text comprehension is challenging for most websites. Conclusion: Private agencies and hospitals managed non-government websites generally outperformed government websites' reliability, quality, and readability. However, overall improvement in Arabic's online health information landscape is essential to enhance accessibility and credibility for colon cancer patients. [ABSTRACT FROM AUTHOR]

Language users routinely use canonical, familiar idioms in everyday communication without difficulty. However, creativity in idiom use is more widespread than sometimes assumed, and little is known about how we process creative uses of idioms, and how individual differences in cognitive skills contribute to this. We used eye-tracking while reading and cross-modal priming to investigate the processing of idioms (e.g., play with fire) compared with creative variants (play with acid) and literal controls (play with toys), amongst a group of 47 university-level native speakers of English. We also conducted a series of tests to measure cognitive abilities (working memory capacity, inhibitory control, and processing speed). Eye-tracking results showed that in early reading behaviour, variants were read no differently to literal phrases or idioms but showed significantly longer overall reading times, with more rereading required compared with other conditions. Idiom variables (familiarity, decomposability, literal plausibility) and individual cognitive variables had limited effects throughout, although more decomposable phrases of all kinds required less overall reading time. Cross-modal priming—which has often shown a robust idiom advantage in past studies—demonstrated no difference between conditions, but decomposability again led to faster processing. Overall, results suggest that variants were treated more like literal phrases than novel metaphors, with subsequent effort required to make sense of these in the way that was consistent with the context provided. [ABSTRACT FROM AUTHOR]

Medication guides (MGs) provide patients with important information about certain prescription drugs to help them take these drugs safely. We surveyed US residents about their perceptions of MG readability and understandability. We randomly sampled 5204 US residents (age 18+) from Ipsos's KnowledgePanel to complete a two-part survey. Only respondents who reported receiving an MG with their prescription drugs (n  = 3852) completed part 2, which included two key items: How easy to [(1) read/ (2) understand ] are the MGs that you have received from a pharmacy along with your prescription medicines? (1 =  Very easy, 5 =  Very difficult ; reverse-coded). Health literacy (HL) and demographic data were also collected. After weighting our data, we found that 85% of respondents who reported receiving an MG perceived this information as 'very easy' (27.3%), 'somewhat easy' (28.3%) or 'about average' (29.3%) to read. Eighty-seven percent of respondents who reported receiving an MG perceived it as 'very easy' (27.6%), 'somewhat easy' (30.2%) or 'about average' (29.5%) to understand. ANOVAs revealed higher average perceived MG reading and comprehension ease scores among respondents presumed to have adequate versus inadequate HL (ps  ≤ 0.0006). Younger or less-educated respondents and non-Hispanic Blacks perceived MGs as easier to read and understand, on average, than their counterparts (p s ≤ 0.0001). Many of these relationships remained intact in models predicting perceived MG reading and comprehension ease (p s ≤ 0.001). Adjusted R 2 values across models were small, however (≤0.06). Our findings suggest most US residents (18+) who received MGs perceived them to be 'about average' to 'very easy' to read and understand. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has significantly disrupted clinical experience and exposure of medical students and junior doctors. Artificial Intelligence (AI) integration in medical education has the potential to enhance learning and improve patient care. This study aimed to evaluate the effectiveness of three popular large language models (LLMs) in serving as clinical decision‐making support tools for junior doctors. Methods: A series of increasingly complex clinical scenarios were presented to ChatGPT, Google's Bard and Bing's AI. Their responses were evaluated against standard guidelines, and for reliability by the Flesch Reading Ease Score, Flesch–Kincaid Grade Level, the Coleman‐Liau Index, and the modified DISCERN score for assessing suitability. Lastly, the LLMs outputs were assessed by using the Likert scale for accuracy, informativeness, and accessibility by three experienced specialists. Results: In terms of readability and reliability, ChatGPT stood out among the three LLMs, recording the highest scores in Flesch Reading Ease (31.2 ± 3.5), Flesch–Kincaid Grade Level (13.5 ± 0.7), Coleman–Lau Index (13) and DISCERN (62 ± 4.4). These results suggest statistically significant superior comprehensibility and alignment with clinical guidelines in the medical advice given by ChatGPT. Bard followed closely behind, with BingAI trailing in all categories. The only non‐significant statistical differences (P > 0.05) were found between ChatGPT and Bard's readability indices, and between the Flesch Reading Ease scores of ChatGPT/Bard and BingAI. Conclusion: This study demonstrates the potential utility of LLMs in fostering self‐directed and personalized learning, as well as bolstering clinical decision‐making support for junior doctors. However further development is needed for its integration into education. [ABSTRACT FROM AUTHOR]