Assessing the readability and quality of online information on anosmia

INTRODUCTION

Anosmia can have a significant impact on well-being and quality of life. Due to an ageing population and the coronavirus disease 2019, increasing numbers of patients are seeking online information on anosmia. This report systematically assesses the readability and quality of online information on anosmia.

METHODS

The terms 'anosmia' and 'loss of smell' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated.

RESULTS

A total of 79 websites met the inclusion criteria. The mean and 95% confidence interval for the FRES, FKGL, SMOG, GFI and DISCERN scores were 46.31 (42.94-49.68), 12.00 (11.27-12.73), 10.70 (10.16-11.23), 14.62 (13.85-15.39) and 2.90 (2.69-3.11), respectively. Significant negative correlation was noted between the DISCERN and FRES (rs=-0.500; p<0.05).

DISCUSSION

Online information on anosmia is written above the recommended reading age guidance in the UK, and has moderate deficiencies in quality. As a result, the information may be used inappropriately and could result in worse health outcomes. We recommend that patients are directed to websites produced by health providers or nonprofit organisations that develop material for patient health education.

CONCLUSIONS

Online information on anosmia is of low readability and moderate quality. Healthcare professionals should direct patients towards high-quality resources written for the layperson.

Assessing the readability and quality of online information on benign paroxysmal positional vertigo

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It can have a significant impact on quality of life, with individuals often seeking information online for reassurance and education. The aim of this study is to assess the readability and quality of online information on BPPV.

METHODS

The terms 'benign paroxysmal positional vertigo' and 'BPPV' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFOG). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated.

RESULTS

A total of 39 websites met the inclusion criteria. The mean and 95% confidence intervals for the FRES, FKGL, SMOG, GFOG and DISCERN scores were 50.2 (46.1-54.3), 10.6 (9.87-11.4), 10.1 (9.5-10.7), 13.6 (12.7-14.4) and 36.7 (34.6-38.7), respectively. Weak correlation was noted between DISCERN and FRES (rs = -0.23, p = 0.17).

CONCLUSION

Online information on BPPV is generally of poor quality and low readability. It is essential that healthcare professionals inform their patients of this limitation and advocate for improved online patient education resources that are both high quality and easy to comprehend.

Cocaine screening in patients undergoing nasal reconstructive surgery: a cross-sectional, survey-based study of UK rhinology consultants

OBJECTIVE

This study aimed to explore the current practices of the UK rhinology consultant body in regard to cocaine screening in nasal reconstructive surgery.

METHOD

A 12-question online survey was distributed to rhinology consultants (October 2021 to February 2022) currently practising in the UK.

RESULTS

A total of 55 consultants responded. Fifty-three per cent asked patients about cocaine use prior to consideration of surgery, and 45 per cent performed cocaine testing prior to consideration of surgery. Of these, the majority employed urine testing alone (60 per cent), with hair testing being less common as a single screening modality (4 per cent). Sixteen per cent opted for both urine and hair testing. The most common reasons for not performing cocaine testing included patient history or clinical examination that was not suggestive of cocaine use (44 per cent), lack of formal guidelines (33 per cent) and lack of testing availability (27 per cent). Sixty-four per cent were in favour of a national policy for cocaine screening.

CONCLUSION

There is marked variation in cocaine screening practices for nasal reconstructive surgery among UK rhinologists.

Assessing the readability and quality of online information on Bell's palsy

OBJECTIVE

This study aimed to evaluate the readability and quality of current online information on Bell's palsy.

METHOD

A Google search using the terms 'Bell's palsy' and 'facial palsy' was performed separately. The first three pages of results were analysed. Readability was assessed using Flesch Reading Ease Score, Flesch-Kincaid Grade Level, the Gunning-Fog Index and the Simple Measure of Gobbledygook. Quality was assessed using the Discern tool. Spearman's correlation between quality and readability was calculated.

RESULTS

A total of 31 websites met the inclusion criteria. The mean Flesch Reading Ease Score, Flesch-Kincaid Grade Level, the Gunning Fox Index and the Simple Measure of Gobbledygook scores were 52.45 (95 per cent confidence interval = 47.01-57.86), 10.50 (95 per cent confidence interval = 9.42-11.58), 12.76 (95 per cent confidence interval = 11.68-13.85) and 9.36 (95 per cent confidence interval = 8.52-10.20), respectively. The average Discern score was 44 (95 per cent confidence interval = 40.88-47.12). A negligible correlation was noted between the Discern and Flesch Reading Ease Score (rs = -0.05, p = 0.80).

CONCLUSION

Online information on Bell's palsy is generally of fair quality but is written above the recommended reading age guidance in the UK.

Functional endoscopic sinus surgery: assessing the readability and quality of online information

INTRODUCTION

The aim of this study was to assess the readability and quality of online information on functional endoscopic sinus surgery (FESS).

METHODS

The term 'functional endoscopic sinus surgery' was entered into the Google, Bing and Yahoo search engines. The first 30 websites for each search engine were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade (FKG), Simple Measure of Gobbledygook (SMOG) Index, and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated.

RESULTS

Thirty-three websites met the inclusion criteria. The mean and standard deviations for the FRES, FKG, SMOG, GFI, and DISCERN scores were 49 (13.1), 10.9 (2.5), 10.2 (1.9), 13.6 (2.4), and 51.1 (12.8), respectively. A positive correlation was noted between the FRES and DISCERN (R=0.357, p=0.041).

CONCLUSIONS

Online information on FESS is generally written above the recommended reading levels and of fair quality.

888 Utility of a Virtual Mock Interview Course to Prepare Trainees on UK Core Surgical Training Interviews – a Cross-Sectional Study

Aim

To assess the usefulness of a virtual mock interview course to prepare trainees for UK Core Surgical Training (CST) interviews.

Method

Junior doctors interested in applying for CST attended a one-day interview course delivered by highly ranked surgical trainees. All attendees were invited to complete pre- and post-interview course questionnaires to assess usefulness in improving the confidence and preparedness for interviews.

Results

A total of 60 trainees attended the course with an 87% (52/60) response rate to both pre- and post-course surveys. Most trainees were FY2 doctors (50%) applying to CST for the first time (78%). Before the course, 60% of attendees reported feeling “not so confident” for their upcoming interview; 38% of participants felt “somewhat confident” whilst 2% reported feeling “very confident.” 100% of doctors found the pre-mock interview presentations “very useful” or “extremely useful”. Matched data revealed an improvement in attendees’ overall confidence (p&lt;0.0001), with 98% reporting they felt “somewhat” or “very confident” and 2% reporting feeling “extremely confident” about upcoming interviews.

Conclusions

We demonstrate evidence of a successful CST virtual mock interview course that significantly aids preparation and improves confidence for junior doctors.

An unusual case of stridor: supraglottic inverted papilloma

Inverted papillomas are rare benign neoplasms that typically originate in the sinonasal area of middle-aged men. We report the first case of a supraglottic inverted papilloma presenting with stridor.

1668 Buying Your Way into A Run-Through Surgical Training Post: The Way Forward?

Introduction

Competition for core surgical training (CST) applications has increased significantly over the last few years. This has been largely attributable to the introduction of limited run-through surgical posts which avoids the bottleneck at ST3 applications. We sought to assess how financial factors may affect current or potential future surgical trainees in their pursuit for run-through posts.

Method

A 10-point questionnaire was designed to assess various financial considerations for surgical trainees applying to the 2021 CST cycle who had the sole goal of securing a run-through post. Results were analysed using Chi-squared test.

Results

Of the 40 respondents, 95% were foundation doctors and 5% were core trainees. There was a significant association between willingness to achieve full marks in the CST interview and attending an interview course and obtaining 1-1 coaching sessions (p &lt; 0.05). Familial income was not found to be a significant barrier to spending money on interview courses and coaching sessions (p &lt; 0.05).

Conclusions

Applicants are willing to pay a significant premium to secure a run-through surgical post. Further research is required to fully understand the reasons behind this phenomenon and the impact on those from widening participation backgrounds.

Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database

BACKGROUND

Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19.

METHODS

This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression.

FINDINGS

Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452).

INTERPRETATION

Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.

729 Effect Of COVID-19 On Orthopaedic Trauma Admissions in A London District General Hospital

Introduction

The coronavirus pandemic (COVID-19) has presented orthopaedic services with new challenges across all aspects of healthcare delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions at a London District General Hospital.

Method

Data was collected retrospectively from electronic patient records during the lockdown period (16th March -30thApril 2020) and compared to the same dates in 2019. Patient age, date and time of admission, operation and anaesthesia timings and length of stay (LOS) were analysed.

Results

Fewer trauma patients were admitted in 2020 (108 vs. 65). Additionally, there was a patient demographics shift, with mean age increasing from 55.6 years to 64.1 years (p = 0.038). Falls remained the leading cause of injury, although the proportion dropped from 75% to 62%. Anaesthesia duration was longer in 2020 (136 vs 83 minutes, p &lt; 0.00001). Similarly, there was a 13.6% increase in median operation length. Finally, although LOS was similar, admission-operation was greatly reduced in 2020 (1.22 days vs 4.74, p &lt; 0.0000001).

Conclusions

Orthopaedic trauma care remains a vital service, particularly in high-volume hospitals. By understanding the effects of the lockdown on trauma admissions, healthcare managers can more effectively plan for future changes in non-emergent trauma service delivery as we move towards easing lockdown restrictions.

Fuchs' Endothelial Corneal Dystrophy in Patients With Myotonic Dystrophy, Type 1

Purpose

RNA toxicity from CTG trinucleotide repeat (TNR) expansion within noncoding DNA of the transcription factor 4 (TCF4) and DM1 protein kinase (DMPK) genes has been described in Fuchs' endothelial corneal dystrophy (FECD) and myotonic dystrophy, type 1 (DM1), respectively. We prospectively evaluated DM1 patients and their families for phenotypic FECD and report the analysis of CTG expansion in the TCF4 gene and DMPK expression in corneal endothelium.

Methods

FECD grade was evaluated by slit lamp biomicroscopy in 26 participants from 14 families with DM1. CTG TNR length in TCF4 and DMPK was determined by a combination of Gene Scan and Southern blotting of peripheral blood leukocyte DNA.

Results

FECD grade was 2 or higher in 5 (36%) of 14 probands, significantly greater than the general population (5%) (P < 0.001). FECD segregated with DM1; six of eight members of the largest family had both FECD and DM1, while the other two family members had neither disease. All DNA samples from 24 subjects, including four FECD-affected probands, were bi-allelic for nonexpanded TNR length in TCF4 (<40 repeats). Considering a 75% prevalence of TCF4 TNR expansion in FECD, the probability of four FECD probands lacking TNR expansion was 0.4%. Neither severity of DM1 nor DMPK TNR length predicted the presence of FECD in DM1 patients.

Conclusions

FECD was common in DM1 families, and the diseases cosegregated. TCF4 TNR expansion was lacking in DM1 families. These findings support a hypothesis that DMPK TNR expansion contributes to clinical FECD.

Correction to: The diagnosis and treatment of primary vitreoretinal lymphoma: a review

[This corrects the article DOI: 10.1186/s40942-018-0120-4.].

The diagnosis and treatment of primary vitreoretinal lymphoma: a review

Background

To describe the recent diagnostic and treatment options for the most predominant form of primary vitreoretinal lymphoma (PVRL), namely diffuse large B cell lymphoma. This is mainly based on the experience at the Mayo Clinic as well as a partial review of the literature. MYD88 L265P mutation is seen in about 80% of cases; therefore, a polymerase chain reaction for this mutation helps in making the diagnosis that has been notoriously difficult to make. Local therapy using intravitreal methotrexate and rituximab has been very helpful in the treatment of the local disease. Systemic high-dose intravenous methotrexate is helpful in treating bilateral disease in conjunction with intravitreal therapy. Whether it is helpful in preventing or delaying the development of central nervous system lymphoma (CNSL) is still in dispute. If there is development of CNSL or recurrent ocular disease, alternatives to high-dose methotrexate under investigation include pomalidomide, stem cell transplantation, or ibrutinib, with or without local therapy. Vitrectomy alone might be helpful as a debulking procedure. Because of the risks of redevelopment of disease, local radiation should be given if other options are not possible. Aqueous levels of IL10 are helpful in following the redevelopment of local disease.

Conclusion

Although PVRL is still a difficult disease to diagnose and treat, new advances are helping to make these easier. Larger collaborative studies will be helpful in determining better treatments.

Aging leads to inferior Achilles tendon mechanics and altered ankle function in rodents

Spontaneous rupture of the Achilles tendon is increasingly common in the middle aged population. However, the cause for the particularly high incidence of injury in this age group is not well understood. Therefore, the objective of this study was to identify age-specific differences in the Achilles tendon-muscle complex using an animal model. Functional measures were performed in vivo and tissues were harvested following euthanasia for mechanical, structural, and histological analysis from young, middle aged, and old rats. Numerous alterations in tendon properties were detected across age groups, including inferior material properties (maximum stress, modulus) with increasing age. Differences in function were also observed, as older animals exhibited increased ankle joint passive stiffness and decreased propulsion force during locomotion. Macroscale differences in tendon organization were not observed, although cell density and nuclear shape did vary between age groups. Muscle fiber size and type distribution were not notably affected by age, indicating that other factors may be more responsible for age-specific Achilles tendon rupture rates. This study improves our understanding of the role of aging in Achilles tendon biomechanics and ankle function, and helps provide a potential explanation for the disparate incidence of Achilles tendon ruptures in varying age groups.

Effect of intravitreal methotrexate and rituximab on interleukin-10 levels in aqueous humor of treated eyes with vitreoretinal lymphoma

Intraocular cytokines are promising diagnostic biomarkers of vitreoretinal lymphoma. Here, we evaluate the utility of IL-10, IL-6 and IL-10/IL-6 for discriminating lymphoma from uveitis and report the effects of intraocular methotrexate and rituximab on aqueous cytokine levels in eyes with lymphoma. This is a retrospective case series including 10 patients with lymphoma and 7 patients with uveitis. Non-parametric Mann-Whitney analysis was performed to determine statistical significance of difference in interleukin levels between lymphoma and uveitis. Compared to eyes with uveitis, eyes with lymphoma had higher levels of IL-10 (U = 7.0; two-tailed p = 0.004) and IL-10/IL-6 (U = 6.0; two-tailed p = 0.003), whereas IL-6 levels were more elevated, although insignificant, in those patients with uveitis than in lymphoma (U = 15.0; two-tailed p = ns). Using a receiver operating characteristic analysis to identify threshold values diagnostic for lymphoma, optimal sensitivity and specificity improved to 80.0% and 100%, respectively, for IL-10>7.025 pg/ml and 90.0% and 100.0%, respectively, for IL-10/IL-6>0.02718. In patients in whom serial interleukin levels were available, regular intravitreal treatment with methotrexate and rituximab was associated with reduction in IL-10 levels over time. In conclusion, optimal IL-10 and IL-10/IL-6 threshold values are associated with a diagnostic sensitivity ≥80% and specificity of 100%. Therefore, these cytokines may serve as a useful adjunct in the diagnosis of lymphoma. While negative IL-10 and IL-10/IL-6 values do not exclude a diagnosis of lymphoma, elevated levels do appear to be consistent with lymphoma clinically. Moreover, elevated levels of IL-10 in the setting of a clinically quiet eye may point to impending disease recurrence. Lastly, once lymphoma is diagnosed, IL-10 levels can be monitored over time to assess disease activity and therapeutic response.

Safety of Tumor Necrosis Factor Inhibitors during Pregnancy and Breastfeeding

PURPOSE

Tumor necrosis factor (TNF) inhibitors are useful in the treatment of numerous inflammatory and immunologic disorders. Since many of these conditions occur in women of childbearing age, safety during pregnancy and breastfeeding is of considerable importance.

METHODS

This paper is a review of the literature on the safety of TNF inhibitors during pregnancy and breastfeeding published between 2001 and 2011.

CONCLUSIONS

TNF inhibitors do not appear to be associated with a high risk of teratogenicity or intrauterine death. However, a small magnitude increase in risk cannot be ruled out given the paucity of data on the subject. Although TNF inhibitor use may be associated with a higher rate of preterm delivery, this may in fact be due to an active, underlying disease. Therefore, the decision to use these medications should be made on a case-by-case basis. If the disease cannot be managed with first line agents, TNF inhibitors may be helpful in reducing the number of disease exacerbations. Nevertheless, when using TNF inhibitors, it is prudent to discontinue treatment around the third trimester when transfer across the placenta is greatest and to restart postpartum.

A rare cause of massive lymphadenopathy

Rosai Dorfman Disease is a rare disease presenting mainly as painless enlargement of cervical lymph nodes. It is a benign disorder showing unique histological features characterized by reactive proliferation of sinus histiocytes. In 40% of cases, extranodal sites may be involved. The condition has to be differentiated from certain types of B cell lymphoma showing similar features. We report here a 17 year old male presenting with nodal and extranodal involvement of Rosai Dorfman Disease.

Immune response in human cerebral cavernous malformations

BACKGROUND AND PURPOSE

Preliminary observations suggesting the presence of B and plasma cells and oligoclonality of immunoglobulin (Ig) G in cerebral cavernous malformations (CCM) have motivated a systematic study correlating the infiltration of the immune cells with clinical activity and antigen-triggered immune response in surgically excised lesions.

METHODS

Infiltration of plasma, B, T, and human leukocyte antigen-DR-expressing cells and macrophages within 23 excised CCM was related to clinical activity. Relative amounts of Ig isotypes were determined. IgG clonality of mRNA from CCM was assessed by spectratyping, cloning, and sequencing.

RESULTS

Infiltration of the immune cells ranged widely within CCM lesions, and cells were generally coexpressed with each other. Immune cell infiltration did not associate with recent bleeding and lesion growth. Significantly more B lymphocytes in CCM lesions were associated with venous anomaly. More T cells were present in solitary lesions. More T cells and less macrophages were present in CCM from younger subjects. IgG isotype was present in all CCM lesions. Most lesions also expressed IgM and IgA, with IgM predominance over IgA correlating with recent CCM growth. Oligoclonality was shown in IgG mRNA from CCM, but not from peripheral blood lymphocytes, with only 8 complementary-determining region 3 sequences observed among 134 clones from 2 CCM lesions.

CONCLUSIONS

An antigen-directed oligoclonal IgG immune response is present within CCM lesions regardless of recent clinical activity. Apparent differences in immune response in younger patients and in lesions with recent growth will need confirmation in other series. The pathogenicity of oligoclonal immune response will require systematic hypothesis testing in recently available CCM murine models.

Inadequate analgesic prescription increases secondary post-tonsillectomy bleed rates: a completed audit loop

A significantly greater than normal secondary haemorrhage rate was noted in patients who had undergone tonsillectomy or adenotonsillectomy as waiting list 'initiative' cases within an alternative healthcare provider setting, compared with patients undergoing the same surgery within a primary healthcare trust (17.8 vs 3.9 per cent, respectively; p 0.1). We conclude that adequate analgesia, for the first week post-tonsillectomy, is essential in order to keep the secondary haemorrhage rate within an acceptable range.