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Background: Bi-modular stems were introduced in primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. Despite numerous reports on modular femoral neck fractures, some designs are still marketed worldwide. While the risk factors for the sudden failure are multifactorial and mostly known, the timing of this new THA complication is not predictable by any means.Case Presentation: In this report, the literature regarding one of the most popular bi-modular stems with specific neck-stem coupling (oval Morse taper) is reviewed and illustrated with a case of bilateral modular neck fracture in a patient with idiopathic aseptic necrosis of femoral heads treated with primary bi-modular THA. Because of bilateral modular femoral neck fracture, which occurred 3 years on the left side and 20 years after implantation on the right side, the patient required a total of 6 revisions and 208 days of hospitalized care.Conclusion: To our knowledge, this is the first report of bilateral modular neck fracture in a single patient. Even though the same surgeon performed both operations and used the same neck length and orientation, fractures occurred with a 17-year time difference after implantation. This shows that we cannot predict with certainty when a fracture might occur. Orthopaedic surgeons should use bi-modular stem designs for primary THA very cautiously. [ABSTRACT FROM AUTHOR]

A two-stage revision total hip replacement (THR) remains the gold standard for treating chronic periprosthetic joint infection. The goals for the first stage are twofold: (1) remove infected tissue/implants, obtaining tissue samples for culture; (2) deliver local antibiotics and maintain hip function with a prosthesis with antibiotic-loaded acrylic cement. With extensive bone loss prefabricated spacers are not sufficient, therefore customised spacers are required. The current technique, coating cephalomedually femoral nail in cement, is complex, time consuming, functions poorly and causes wear debris from excessive friction at the femoral/acetabular articulation. We report a technique to create a custom made composite spacer using a short femoral nail, standard Exeter femoral stem (Stryker), Trident acetabular cup (Stryker) and polymethyl methacrylate (PMMA) bone cement with antibiotics. This technique restores hip biomechanics and gives a stable articulation, even in the presence of abductor deficiency, due to dual mobility bearings. [ABSTRACT FROM AUTHOR]

Background: Existing research on health literacy identifies a disconnect between the readability of patient education materials (PEMs) and the reading abilities of American adults. For people with age-related macular degeneration (AMD), central vision loss creates an additional barrier to health literacy. This study explored how evidence-based guidelines for creating easy-to-understand written materials influenced the usability of PEMs in people with AMD. Methods: Evidence-based guidelines were applied to modify one PEM. Standardized tools quantified differences in readability and suitability between the original and modified PEM. Twelve people with AMD rated the comprehensibility (design quality) and shared personal preferences during semi-structured interviews. Results: The modified PEM showed statistically significant improvements in readability, suitability, and comprehensibility. Mean readability decreased 5.9 grade levels. Suitability increased from 20% (not suitable) to 82% (superior). Comprehensibility also improved significantly. The majority of the participants indicated the modified PEM made information easier to read (75%), understand (83%) and locate (92%). Qualitative analysis revealed themes related to reading challenges, optical devices, and patient-provider interactions. Conclusion: Applying evidence-based guidelines for low health literacy and low vision created a significant improvement in the usability of written health information. Actively involving people with AMD in the research provided valuable insight. Additional research is warranted [ABSTRACT FROM AUTHOR]

Background: Patients are frequently provided with medicine information materials (MIMs). Rendering medicine information through written material is a reliable method. Readability is an important attribute of written material that can affect the reader's ability to comprehend. Patient's perception can also affect the comprehensibility of written MIMs. Objective: The objectives of the study were to assess the readability of medicine information in Tikur Anbessa Specialized Hospital (TASH); and assessing patients' perception and understanding of medicine information materials. Methods: This was a cross-sectional study conducted from September 21, 2019 to November 24, 2020, at TASH. Quantitative and qualitative data collection approaches were used in this research. The readability value of each material was determined in accordance with the Flesch Reading ease scores (FRE) and Flesch-Kincaid Grade Level (FKGL). The tools compute readability based on an average number of syllables per word and an average number of words per sentence. FRE provides scores from 0 to 100; higher scores mean easily comprehensible while FKGL sets grade levels for written texts. A structured interview was administered with questions about how MIMs had been used, and was analyzed qualitatively. Results: The results of this research showed low readability scores of MIMs found in TASH. Most patients do not get MIMs and are unaware of how to use them. They are interested to receive and read medicines information from pharmacists and physicians. Moreover, most of them preferred information through both verbal and written forms. Conclusion: The readability levels of selected MIMs obtained from TASH are found to be not compliant with the patients' needs. This might be worsening their health outcomes and resulting in poorer use of healthcare services. [ABSTRACT FROM AUTHOR]

Introduction: The impact of residual internal fixation devices on subsequent procedures about the hip has not been clearly well defined. The objective of the current study is to evaluate the outcome of hip arthroplasty after hardware retrieval as a one-stage replacement, to analyze possible differences related to the type of removed implant, and to assess the impact of unexpected intraoperative cultures during implant retrieval. Materials and methods: We present a retrospective study including all those cases undergoing hip arthroplasty with concomitant hardware removal (cannulated screws, intramedullary nail, or dynamic hip screw) from 2005 to 2018. We evaluated demographics, intraoperative cultures, early infection rate, and other complications. Results: A total of 55 cases were included in the study. The median time between the implant surgery and the hip arthroplasty was 113 days. The removed devices included 6 cannulated screws, 34 intramedullary nails, and 15 dynamic hip screws. Up to 74.5% of the failed osteosynthesis belonged to intertrochanteric femoral fractures. Dislocation rate was 9.1% (1.8% requiring revision surgery), 25.5% of the cases needed further new surgeries after the hip arthroplasty, and 49.1% died during the follow-up period. Any-cause revision surgery and mortality rates were significantly increased after intramedullary nail removal. Intraoperative cultures were performed in 46 cases, and in 9 (16.4%), there was bacterial contamination: 6 cases (10.9%) presented one single positive culture and 3 (5.5%) presented ≥ 2 positive cultures for the same microorganism. A total of five cases (9.1%) presented early prosthetic joint infection that required debridement. None of these five cases had presented positive cultures at the implant removal. Conclusion: According to our results, hip arthroplasty with concomitant hardware removal is related to a high 5-year mortality rate, mainly when intramedullary nail is retrieved. Whereas a high risk of early prosthetic joint infection is associated, it seems not to be related to the elevated presence of unexpected positive cultures. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this systematic review and meta-analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties. Methods: A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient-related and procedure-related factors. Meta-analysis (random-effects models) was conducted using odds ratio (OR) and mean difference (MD). Risk of bias (ROBBINS-I) and strength of the evidence (GRADE) were assessed. Results: The study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = − 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score ≥ 3 and obesity were also significantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors. Conclusions: The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modifiable risk factors for PJI should be attempted in clinical practice. Level of evidence: II. [ABSTRACT FROM AUTHOR]

The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(1):38-42.]. [ABSTRACT FROM AUTHOR]

Background: Low literacy skills impact important aspects of communication, including health-related information exchanges. Unsuccessful communication on the part of physician or patient contributes to lower quality of care, is associated with poorer chronic disease control, jeopardizes patient safety and can lead to unfavorable healthcare utilization patterns. To date, very little research has focused on digital communication between physicians and patients, such as secure messages sent via electronic patient portals. Method: The purpose of the current study is to develop an automated readability formula to better understand what elements of physicians' digital messages make them more or less difficult to understand. The formula is developed using advanced natural language processing (NLP) to predict human ratings of physician text difficulty. Results: The results indicate that NLP indices that capture a diverse set of linguistic features predict the difficulty of physician messages better than classic readability tools such as Flesch Kincaid Grade Level. Our results also provide information about the textual features that best explain text readability. Conclusion: Implications for how the readability formula could provide feedback to physicians to improve digital health communication by promoting linguistic concordance between physician and patient are discussed. [ABSTRACT FROM AUTHOR]

The American Medical Association (AMA) and National Institutes of Health (NIH) currently suggest that health care materials be written at a sixth-grade reading level. Our study investigates the readability of online information on Achilles rupture and reconstruction. Achilles tendon rupture, Achilles tendon repair, and Achilles tendon reconstruction were queried using advanced search functions of Google, Bing, and Yahoo!. Individual websites and text from the first 3 pages of results for each search engine were recorded and categorized as physician based, academic, commercial, government and nongovernmental organization, or unspecified. Individual readability scores were calculated via 6 different indices: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index along with a readability classification score and average grade level. A total of 56 websites were assessed. Academic webpages composed the majority (51.8%), followed by physician-based sources (32.1%). The average overall grade level was 10.7 ± 2.54. Academic websites were written at the highest-grade level (11.5 ± 2.77), significantly higher than physician-based websites (P = .040), and only 2 were written at, or below, a sixth-grade reading level. Currently, online information on Achilles tendon rupture and reconstruction is written at an inappropriately high reading level compared with recommendations from the AMA and NIH.Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Phenylketonuria (PKU) is a condition that results in the build-up of phenylalanine in the blood. This can cause severe brain damage and neurological issues if left untreated. Management can be complex and many individuals may turn to the internet to access further information. It is important that resources are understood as misinterpretation could result in harm to health. The aim of this study was to assess the readability of online resources for PKU and to assess their visual appearance using a communication sciences assessment framework. We searched the top five websites through Google using the search term "phenylketonuria/PKU". We then analysed the text content of the identified websites using five readability formulae to determine the USA and UK reading grade. The median readability level across the five websites was US grade/UK grade 10.6/11.6, with individual grades ranging from 10/11 to 13.3/14.3. We found wide differences in the focus, layout and general appearance of the websites. The readability of resources was much higher than the recommended US 6th grade level. Online resources for PKU need to be simplified to ensure they can be easily understood. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. AMD makes reading challenging and inefficient. People with AMD often find it difficult to access, process and understand written patient education materials (PEMs). To promote health literacy, the demands of written PEMs must match the literacy capacities of the target audience. This study aims to evaluate the readability (grade level) and suitability (appropriateness) of online PEMs designed for people with AMD.Methods: Online PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for "superior" material.Results: One hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0-16.6). The mean suitability score was 53% (range 18-78%). Only six (6%) of PEMs achieved the recommended guidelines for readability level and suitability score.Conclusion: The majority of online PEMs designed for people with AMD were written above the recommended readability level, and below the suggested suitability score. To promote health literacy, the demands of written health information must match the reading capacities of the target audience. Heeding to evidence-based guidelines for providing written information to patients with low health literacy and low vision is beneficial for both patients and health care providers. Future research is warranted. [ABSTRACT FROM AUTHOR]

Acceptable Use Policies (AUPs) are documents stating the limitations users must agree to when first accessing information and communications technologies (ICTs) in organisations, such as employers, educational institutions and public libraries. AUPs lay out the parameters of acceptable use expected of someone accessing the ICT services provided, and should state in clear and understandable terms what behaviours will attract sanctions, both legal and in terms of restricting future access. Utilising a range of standard readability tests used to measure how understandable documents are, the paper investigates how readable the AUPs presented to public library patrons in the UK are in practice. Of the 206 AUPs in use across the local government departments who manage public library services 200 were obtained and subjected to a range of readability testing procedures. Four readability tests were used for analysis: the Flesch Reading Ease, the Coleman-Liau Index, the Gunning Fog Index and the SMOG Grade. Results for all four readability tests administered on all AUPs raise significant questions. For the Flesch Reading Ease score only 5.5% of AUPs scored at the standard readability level or higher (60+), and 8% scored at a very high level of difficulty akin to a piece of scientific writing. Similarly, for SMOG, only 7.5% of the 200 AUPs scored at the recommended level of 10. Likewise, very few AUPs scored at levels recommended for a general audience with either the Gunning Fog Index (11.5%) or the Coleman-Liau Index (2%). With such variability in readability, the fitness for purpose of the average AUP as a contract patrons must agree to can be called into question. This paper presents the first ever analysis of the readability of library AUPs in the literature. Recommendations are made as to how public library services may improve this aspect of practice. [ABSTRACT FROM AUTHOR]

Background: To date, only limited literature exists regarding revision of total hip arthroplasty (THA) through the direct anterior approach (DAA). However, as the popularity of the DAA for primary surgery is increasing, surgeons will be confronted with the challenge of performing revision surgery through the DAA. The aim of this study was to review the potential of the DAA in the revision setting and to report the clinical results, radiologic outcomes and complication rates of 63 patients undergoing revision THA through the DAA. Methods: From 01/2009 to 08/2017, 63 patients underwent revision THA through the DAA. Depending on the performed procedure, patients were separated into 4 groups: liner and head exchange (21 patients), revision of the acetabular cup (26 patients), revision of the femoral stem (13 patients) or revision of both components (3 patients). Postoperative complications as well as the clinical and radiological outcome were assessed retrospectively. Results: At a mean follow-up of 18 months, the overall complication and re-operation rates were 14.3% and 12.7%, respectively. Specifically, the complication and re-operation rates were 14.2% and 9.5% after liner and head exchange, 15.4% after revision of the acetabular cup, 15.3% after revision of the femoral stem and 0% after revision of both components. The mean postoperative HHS at 1 year postoperatively was 91 (range 74–100). Conclusion: The DAA offers appropriate exposure for exchange of mobile liners and acetabular cup revision. In selected cases with appropriate stem design, femoral stem revision through the DAA is feasible. However, surgeons should be aware of the technical difficulties related to femoral revision and be prepared to extend the approach distally or perform a trochanteric osteotomy. [ABSTRACT FROM AUTHOR]

Background: Patients with limited health literacy require online educational materials to be written below a sixth grade level for optimal understanding. We assessed the quality, accuracy, and readability of online materials for Kienböck disease (KD). Methods: "Kienbock's Disease" and "Lunate Avacular Necrosis" were entered into 3 search engines. The first 25 Web sites from each search were collected. Quality was assessed via a custom grading rubric, accuracy by 2 residents and a fellow, and readability by Flesch-Kincaid grade level (FKGL) and New Dale-Chall test. Web sites were stratified according to the search term, FKGL, order of appearance, and authorship type. Results: A total of 38 unique Web sites were included, of which 22 were assigned to "KD" and 16 to "Lunate Avascular Necrosis." The average quality score out of 30, accuracy score out of 12, and FKGL for all Web sites were 13.3 ± 7.3, 10.4 ± 1.9, and 10.5 ± 1.4, respectively. Web sites assigned to the term "Kienbock's Disease" had a significantly higher FKGL. Web sites of higher FKGL had significantly worse accuracy scores. Order of appearance had no influence. Physician specialty societies (PSS) had a significantly lower FKGL than Web sites of other authorship types. Conclusions: Despite concerted efforts by national organizations, the readability of online patient materials is above the recommended level for KD. Patients with limited health literacy will be most affected by this reality. Until readability improves, patients should continue to consult their physicians when uncertain and prioritize Web sites that are easier to read and produced by PSS. [ABSTRACT FROM AUTHOR]

Objective: Patient education materials (PEMs) are commonly used for patient education. This study assessed readability, format quality, accuracy, understandability and actionability of printed asthma PEMs available in primary care in Singapore. Methods: Primary care in Singapore is provided by island-wide polyclinics and private general practices. We invited the three polyclinic healthcare groups and private general practices via the Primary Care Research Network to submit asthma-related PEMs. Readability was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch–Kincaid (FK) score. Format quality was assessed using "Clear-print and large-print golden rules" from UK Association for Accessible Formats (UKAAF). Understandability and actionability were evaluated using Patient Education Materials Assessment Tool – Printed. Three pulmonologists assessed content accuracy. Results: Thirty leaflets were assessed. SMOG and FK estimated 93% (mean 9.3, range 5–14, SD 1.8) and 47% (mean 6.8, range 2.4–9.9, SD 2.0) exceeded the recommended sixth-grade reading level, respectively. About a third (37%) were fully concordant with UKAAF guidelines, with poor format quality contributed by small font size, poor text emphasis methods, and not using left-aligned text. Leaflets generally scored well in both understandability (mean 84%) and actionability (mean 72%). Thirteen leaflets were inaccurate, 92% of which contained at least one inaccuracy judged to have potentially harmful consequences to patients, including wrong emergency advice. Conclusion: While understandability and actionability are adequate, current asthma PEMs are limited by inappropriately high reading levels, poor format quality and inaccuracies. Healthcare professionals need to assess patients' reading abilities and ensure PEMs are accurate and suitable for their patients. [ABSTRACT FROM AUTHOR]

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Background: Although migraine is recognized as one of the most common and disabling diseases in the world, it is nonetheless still underestimated, underdiagnosed, and undertreated. The fact that migraine patients often tend to access the Web to search for headache‐related information hinders patient‐doctor relationships and one should also bear in mind that, unfortunately, text readability and medical literacy in the overall population may be the reason why patients' understanding of health information is compromised. Aim: We aimed to assess the readability of the home page of the top 10 patient – oriented migraine‐related websites and the educational level required to be in a position to broach them. Methods: On April 15, 2018, we conducted a descriptive study on the international version of Google by entering the words "headache" and "migraine." We then analyzed the overall level of readability of texts of the home pages of the top 10 patient‐oriented websites, by means of the Simple Measure of Gobbledygook Readability Calculator. Results: Entering "headache" on the home pages of the top 10 patient‐oriented websites on Google we found that to understand these particular websites with ease, an average grade level of 12.4 (±1.5 standard deviation, SD) and an average 13.3 years of formal education (±1.7 SD) were required. Similarly, typing "migraine" on Google we found an average grade level of 10.8 (±1.2 SD) and an average of 12.5 years of formal education (±1.9 SD) were required. The most frequently viewed websites all failed to meet the USA National Institutes of Health guidelines, which recommend a range between 6th and 7th grade level readability. Discussion: The present study shows the low readability level resulting from the top 10 patient‐oriented headache/migraine websites and the consequent barrier this creates in the dissemination of headache/migraine‐related medical information. Although the actual physicians, both primary care physicians and headache specialists are the principal source of understandable headache‐related information, only a minority of people consult these professionals. Given the foregoing, the majority of migraine patients is, therefore, unable to obtain adequate comprehensible health information on the Web. Furthermore, the existing gap between migraine‐related website content readability and the unmet need for migraine patients to obtain pertinent and correct information might well contribute to the worldwide neglect of migraine as a major public health problem. Conclusion: Physician experts in headache and migraine should actively cooperate in planning informative material to establish what information patients need to know, how they should use it, and how readable that material actually is. Readability ought to be established before the final website publication. Plain language ought to be used and written messages should be supplemented with visual content such as simple drawings. We recommend the setting up of a new dynamic, modern, plain‐talking, and efficient approach in communication aimed at catching the public's attention with its readability and thus satisfying a migraine and headache web scenario. [ABSTRACT FROM AUTHOR]

Understanding safe food practice is important for home‐based food operators to prevent foodborne illness. Earlier work has found that home‐based food operators lack food safety knowledge and may benefit from training that is specifically tailored to their needs. Unfortunately, home‐based food operators may be deterred from enrolling in traditional educational formats due to their busy schedules. The objective of this study was to pilot and evaluate the effectiveness of an online food safety education module for home‐based food operators in Iowa through three learning assessments. Twenty‐one participants enrolled in a blended workshop in which participants completed one online module before attending a face‐to‐face session where they completed the remaining five modules. The effectiveness of the online module was measured by examining the first‐attempt average scores on learning assessments, the number of assessment attempts required to achieve 100%, and the first‐attempt performance by question type. The three learning assessment tools resulted in first‐attempt averages of approximately 86%, 90%, and 83%, surpassing our standard of effectiveness of 75% and showing good potential for the online format. The learning assessment attempt numbers of 4.65, 1.67, and 3.81 showed difficulty with knowledge transfer for some topics. Comprehension and analysis‐style questions had first‐attempt success rates of approximately 85% and 88%, respectively. Scores on knowledge and application‐style questions were lower with first‐attempt success rates of approximately 80% and 75%, respectively. These findings were used to improve the first online module and guide the transition of the remaining five modules to the online format. [ABSTRACT FROM AUTHOR]

Objective: To assess the overall readability of five currently available hyperacusis questionnaires and to assess the variability of single items within each questionnaire. Design: Comparative study of self-report hyperacusis questionnaires: (1) Geräuschüberempfindlichkeits-Fragebogen (GUF), (2) Noise Avoidance Questionnaire (NAQ), (3) Hyperacusis Questionnaire (HQ), (4) Sound Sensitive-Tinnitus Index (SSTI), and (5) Inventory of Hyperacusis Symptoms (IHS). Well-established readability formulas Flesh-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), Simple Measure of Gobbledygook (SMOG) and FORCAST and a computerised readability calculation software were used. Study sample: Five questionnaires. Results: Reading levels calculated by each formula varied for every questionnaire. Readability scores ranged from 7.7th to 12.7th grade for overall readability depending on the questionnaire. This exceeded the grade reading levels of 5th–6th grade (10–12 years old) as recommended by the American Medical Association or 7th–8th grade (12–14 years old) as recommended by the US National Institutes of Health. Single item readability analysis based on FKGL revealed that 32%–70% of single items are written above the recommended grade levels. Conclusion: All five questionnaires are written at close to or exceeding the recommended grade levels. This requires attention from developers but also when interpreting the questionnaire scores obtained in clinic. [ABSTRACT FROM AUTHOR]

Rationale: Abdominal aortic aneurysm (AAA) is a prevalent condition among elderly men and may require surgical repair. Recent technical advances offer new opportunities to provide patients and next of kin with tailored and individualised information. eHealth tools have proven useful in other patient cohorts, but there are currently no validated educational eHealth tools for patients with AAA. Aim: Our aim was to develop and evaluate an eHealth tool for patients with abdominal aortic aneurysm using a participatory design process. Method: Patients, healthcare professionals and a technical team were involved in the development of the eHealth tool. The tool was assessed for content and usability through questionnaires, validated instruments and focus group interviews. Readability was assessed using Flesch Reading Ease Score (FRE) and Flesch–Kincaid Grade Level (FKGL). Interview data were analysed using thematic content analysis. Results: Factual content and illustrations were accurate and in line with current information routine. Readability assessments produced a mean FRE score of 42.2 (±3,7) and mean FKGL of 10 (±1), implying that the eHealth tool may be difficult to comprehend for certain users. However, participants in the focus group interviews found the tool to be understandable, relevant and easy to use. Conclusion: The developed eHealth tool is acceptable, understandable and usable for the potential end‐users. Further evaluation of the usability of the tool and effect on outcome in clinical care is warranted. This is the first educational eHealth tool for patients with AAA and has potential to contribute to improved communication and quality of care for AAA patients. [ABSTRACT FROM AUTHOR]

High Blood Pressure (BP) is a vital factor in the development of cardiovascular diseases worldwide. For more than a decade now, patients search for quality and easy-to-read Online Health Information (OHI) for symptoms, preventions, therapy and other medical conditions. In this paper, we evaluate the quality and readability of OHI about high BP. In order that the first 20 clicks of three top-rated search engines have been used to collect the pertinent data. Using the exclusion criteria, 25 unique websites are selected for evaluation. The quality of all included links is evaluated through DISCERN checklist, a questionnaire for assessing the quality of written information for a health problem. To enhance the reliability of evaluation, all links are separately assessed by two different groups—a group of Health Professional (HPs) and a group of Lay Subjects (LS). A readability test is performed using Flesch-Kincaid tool. Fleiss' kappa has been calculated before considering average value of each group. After evaluation, the average DISCERN value of HPs is 49.43 ± 14.0 (fair quality) while for LS, it is 48.7 ± 12.2; the mean Flesch-Reading Ease Score (FRES) is 58.5 ± 11.1, which is fairly difficult to read and the Average Grade Level (AGL) is 8.8 ± 1.9. None of the websites scored more than 73 (90%). In both groups, only 4 (16%) websites achieved DISCERN score over 80%. Mann-Whitney and Cronbach's alpha have been computed to check the statistical significance of the difference between two groups and internal consistency of DISCERN checklist, respectively. Normality and homoscedasticity tests have been performed to check the distribution of scores of both evaluating groups. In both groups, information category websites achieved high DISCERN score but their readability level is worse. Highest scoring websites have clear aim, succinct source and high quality of information on treatment options. High BP is a pervasive disease, yet most of the websites did not produce precise or high-quality information on treatment options. [ABSTRACT FROM AUTHOR]

A descriptive cohort study to determine new mothers' preferred modality for educational materials, and if the format impacted the mothers' perception of an evidenced-based practice safe sleep program. The sample included new mothers anticipating discharge from a mother–baby unit with their newborn. Participants responded to a four-item survey administered by a research assistant. Respondents' self-reported preferred format for patient education was technology-based materials in both cohorts. The video teaching material as compared with the paper handout was rated significantly higher by participants. Modalities of patient education in health care organizations need to be consistent with the changing ways people are learning and accessing information in their everyday life. [ABSTRACT FROM AUTHOR]

Background: Patients are increasingly using the Internet to access health information. Patient awareness and education are crucial to advancing the field of PM&R, but many U.S. adults have insufficient health literacy skills to read and understand patient education materials (PEM), frequently written at the 10th-15th-grade level. Reading ability is key for health literacy, but no previous research has assessed the readability of PEM provided by professional PM&R societies.Objectives: Evaluate whether the readability of PM&R PEM meets the NIH-recommended eighth-grade reading level; compare readability of PM&R PEM to two commonly accessed patient resources for sports and rehabilitation medicine topics, handouts from the American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Family Physicians (AAFP), whose readability has been previously analyzed.Design: Cross-sectional study.Methods: Publicly accessible entries within the patient education section of websites sanctioned by professional PM&R societies, as well as the AAOS and AAFP, were analyzed for readability using two validated and widely used tools, the Flesch-Kincaid Grade Level (FKGL) and Simplified Measure of Gobbledygook (SMOG) formulas. Comparative statistics were performed between the three surveyed specialties.Main Outcome Measures: FKGL and SMOG readability scores, which estimate U.S. grade level, or years of education, needed to comprehend text.Results: A total of 167 online PM&R resources were identified and compared to 94 articles from AAOS and 65 from AAFP. Mean SMOG and FKGL levels exceeded the eighth-grade level for both PM&R (SMOG-9.71, 95% CI 9.42-10.0; FKGL-10.35, 95% CI 9.99-10.7) and AAOS (SMOG-9.15, 95% CI 8.96-9.35; FKGL-9.51, 95% CI 9.29-9.74), whereas AAFP met readability guidelines for both measures (SMOG-7.00, 95% CI 6.74-7.27; FKGL-6.76, 95% CI 6.45-7.07). SMOG and FKGL scores suggested significantly higher reading difficulty for PM&R compared to AAOS (SMOG P = .017; FKGL P = .0001) and AAFP (SMOG P < .0001; FKGL P < .0001). Results indicated that 17% of PM&R resources complied with NIH guidelines, vs 8% for AAOS and 83% for AAFP.Conclusions: The average readability of PM&R PEM exceeds the NIH-recommended and average U.S. adult eighth-grade reading level. The physiatry community can make its patient materials more comprehensible and accessible for patients by providing resources at a more appropriate reading level. [ABSTRACT FROM AUTHOR]

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ± 2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ± 2.2 and 9.7 ± 2.1 sequentially. The mean Coleman-Liau index score was 10.0 ± 1.5, and the average Fry Readability score was 9.9 ± 2.0. The automated readability index for all websites was 10.3 ± 2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ± 10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: In 2020, more than 14,000 aseptic revision procedures for total hip arthroplasty (THA) were registered in Germany. Patient expectations of revision hip arthroplasty are not substantially different from expectations of primary hip replacement., Outcome: However, revision surgery is associated with increased complication rates and a higher proportion of dissatisfied patients. In particular, poorer postoperative function and mobility as well as increased pain levels following revision THA have been described compared to the outcome after primary THA. Quality of life and return-to-work can also be impaired., Survival Rate: Implant survival is influenced by age, BMI, and comorbidities of the patients, but also by the size and complexity of bone defects, the extent of periprosthetic soft tissue compromise and the choice of revision implant(s). In addition, the number of previous revision surgeries inversely correlates with the survival rates. Previous revisions have been shown to be associated with increased risks of aseptic loosening, instability and periprosthetic infection., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

What is known and objective: Preparation of patient‐facing materials of a complex topic, such as describing new vaccines for COVID‐19, is difficult to accomplish. This study examined the readability of patient information leaflets accompanying approved COVID‐19 vaccines. Comment: Readability of patient‐facing literature by the medicines regulator in the United States and the United Kingdom describing the recently US (FDA) and UK (MHRA) COVID‐19 approved vaccines (Pfizer/BioNTech, AstraZeneca, Moderna) was assessed employing 10 metrics. Analyses showed that showed that this material had a Flesch Ease of Reading score of 53.5 and 54, respectively and a Flesch‐Kincaid reading age of between 7th and 8th Grade (12–13 year olds) and between 8th and 9th Grade (13–14 year olds), respectively. When compared to a recent study on COVID‐19 information on healthcare websites, the vaccine literature readability was favourable. What is new & conclusion: Adoption of readability calculators and scrutiny of materials of their readability will help authors develop materials with improved understanding for COVID‐19 vaccine recipients, carers and family, potentially leading to improved health literacy and vaccine uptake. [ABSTRACT FROM AUTHOR]

Objectives: Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. Methods: An online Google search using the terms "office vocal fold injection medialization" and "awake vocal fold injection" was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Results: Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P <.05) and FKGL (P <.05) scores, and lower FRES (P <.05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P <.05) and higher FKGL (P <.05) scores, and there was a trend toward significance for higher DISCERN scores (P =.052). Conclusions: Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates. [ABSTRACT FROM AUTHOR]

Dislocation after hip arthroplasty is still a major concern. Recent study of the volumetric wear of the cup has suggested that stresses studied in a one-legged stance model could predispose arthroplasty dislocation. The aim of this work was to study whether biomechanical parameters of contact stress distribution in total hip arthroplasty during a neutral hip position can predict a higher possibility of the arthroplasty dislocating. Biomechanical parameters were determined using 3-dimensional mathematical models of the one-legged stance within the HIPSTRESS method. Geometrical parameters were measured from standard anteroposterior X-ray images of the pelvis and proximal femora. Fifty-five patients subjected to total hip arthroplasty that later suffered dislocation of the head and, for comparison, ninety-four total hip arthroplasties that were functional at least 10 years after the implantation, were included in the study. Arthroplasties that suffered dislocation had on average a 6% higher resultant hip force than the control group (p = 0.004), 11% higher peak stress on the load-bearing area (p = 0.001) and a 50% more laterally positioned stress pole (p = 0.026), all parameters being less favorable in the group of unstable arthroplasties. There was no statistically significant difference in the gradient index or in the functional angle of the weight bearing. Our study showed that arthroplasties that show a tendency to push the head out of the cup in the representative body position—the one-legged stance—are prone to dislocation. An unfavorable resultant hip force, peak stress on the load bearing and laterally positioned stress pole are predictors of arthroplasty dislocation. [ABSTRACT FROM AUTHOR]

Background: Cleft lip and palate are among the common birth defects in the United States. Management is complex and may be difficult for parents and patients to understand. The goal of this study was to evaluate the readability of online educational material provided by the American Society of Plastic Surgeons (ASPS) and the American Cleft Palate-Craniofacial Association (ACPA) websites regarding cleft lip and palate and to assess parents' comprehension. Methods: Parents of children younger than 10 years of age presenting to the plastic and reconstructive surgery clinic at Johns Hopkins All Children's Hospital for conditions other than cleft lip and palate were recruited for participation. Parents were given the literature published on the ASPS and ACPA web sites to review and were asked to complete a 5-question test specifically targeted to the content of the passage they reviewed. We tested the readability of the 2 online passages using Readability Studio software (Oleander Software Solutions Ltd). Results: Sixty parents completed the study. Across all groups, the mean score was 4.35 of a possible 5. The mean score was 4.4 for the ASPS web site and 4.29 for the ACPA web site. Fifty-three percent of participants answered all questions correctly. No significant difference in scores was noted between web sites (P =.48). Conclusions: Despite containing content of varying reading-level difficulty, the literature posted on the ACPA and ASPS web sites concerning cleft lip and palate conveyed information equally well to the target parent demographic with high levels of comprehension. [ABSTRACT FROM AUTHOR]

Background: Only 12% of Americans possess proficient health literacy skills. Among those with the lowest health literacy are individuals with chronic health conditions. Occupational therapists are well prepared to assist these clients with health literacy, given our roles in teaching new health management skills and health promotion. Methods: An educational course was designed and taught to over 100 individuals and caregivers with chronic health conditions to assist in finding and determining trustworthy health information online. An author designed pre postsurvey was used to evaluate effectiveness. Results: There was a significant pre-post change in four categories: finding quality health information online (M = 0.703), judging trustworthiness of online health information (M = 0.624), understanding health information (M = 0.489), and retrieving information using email alerts (M = 0.826). Conclusion: The ability to find and evaluate health information online empowers clients to fully participate in medical care. Evidence shows that this skill can be efficiently taught to clients or client groups for improved health management. Providing training in finding trustworthy health information online is a skill that occupational therapists can successfully teach in conjunction with overall health management skills for improved occupational participation. [ABSTRACT FROM AUTHOR]

Background: The benefits of patient-reported outcome measures (PROMs) are well known; however, their readability has come into question because multiple PROMs have been found to be incomprehensible to patients. This is a critical safety and equity consideration because PROMs are increasingly being integrated into routine clinical practice. A key strategy for promoting patient comprehension is the use of plain language. The aim of this study was to determine whether PROMs routinely used in the cancer setting meet plain-language best practices.Methods: To report the plain-language level of each PROM, readability (Fry Readability Graph, Simple Measure of Gobbledygook, Flesch Reading Ease, and FORCAST) and understandability assessments (Patient Education Materials Assessment Tool [PEMAT] for Printable Materials) were performed. PROMs at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet plain-language best practices. PROMs were divided into 4 domains (physical, emotional, social, and quality of life) and 17 dimensions (eg, pain was a dimension of the physical domain). A subanalysis was conducted to determine whether specific domains and dimensions were more likely to adhere to plain-language best practices.Results: More than half of the 45 PROMs evaluated (n = 33 [73%]) had a grade level higher than 6. Understandability scores ranged from 29% to 100%. The majority of the PROMs that did not meet plain-language best practices were within the physical and emotional domains and focused on the patient's symptom experience.Conclusions: This evaluation shows that more than half of the most commonly used cancer PROMs do not meet plain-language best practices. Practice implications include the necessity for plain-language assessment during the PROM validation process, the consideration of plain language in PROM selection, and plain-language review and editing of low-scoring PROMs. [ABSTRACT FROM AUTHOR]

Background Patient education materials (pems) are frequently used to help patients make cancer screening decisions. However, because pems are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening pem, and we compared how the co-created pem and a pem developed by experts affected decisional conflict and screening intention in patients. Methods We identified and used patient barriers to pca screening to co-create a pca screening pem with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created pem (intervention) or an expert-created pem (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation. Results Of 287 participants randomized to exposure to the co-created pem, 230 were analyzed, and of 287 randomized to exposure to the expert-created pem, 223 were analyzed. After pem exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (ci): -2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk-benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% ci: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% ci: -0.06 to 0.24]). Conclusions The effectiveness of the co-created pem did not differ from that of the pem developed by experts. Thus, pem developers should choose the method that best fits their goals and resources. [ABSTRACT FROM AUTHOR]