Laypeople's (Mis)Understanding of Common Medical Acronyms.

OBJECTIVES: Abbreviations are often used in medicine yet may be a source of confusion for patients and their families. We aimed to determine the general public's understanding of commonly used medical acronyms. METHODS: For this cross-sectional study, we surveyed state fair visitors regarding their understanding of 5 common medical acronyms. An electronic survey was administered to a volunteer sample of adults who spoke and read English and who had never trained to work in medicine or nursing. Free-text responses were coded as correct, partially correct, or incorrect by 2 independent researchers, adding a third researcher if consensus was not reached. Analysis methods included descriptive statistics, Fisher exact tests, and multivariable logistic regression models. RESULTS: We recruited 204 volunteers (55% female; mean age 43 years; 67% had a bachelor's degree or higher). ED (emergency department) was correctly defined by 32%, PCP (primary care provider/physician) by 18%, CBC (complete blood count) by 14%, and PRN (as needed) and NPO (nothing by mouth) by 13% each. Female gender was associated with higher odds of correctly understanding NPO (odds ratio, 3.11; 95% confidence interval, 1.18-8.21; P = .02); older age was associated with higher odds of understanding PRN (odds ratio, 1.03; 95% confidence interval, 1.00-1.05; P = .04). Education level was not found to correlate significantly with successful explanation of any tested acronym. CONCLUSIONS: Medical acronyms are a predictable source of miscommunication. In this large cross-sectional study, none of the acronyms evaluated was understood correctly by more than one-third of adults. Clinicians should avoid using acronyms with patients and families to minimize confusion.

Jargon Be Gone - Patient Preference in Doctor Communication.

While it has been shown that healthcare providers often use medical jargon, less is known about how patients prefer their clinicians communicate. This mixed-methods study aimed to better understand the general public's preference in healthcare communication. A volunteer cohort of 205 adult attendees at the 2021 Minnesota State Fair was presented a survey with two scenarios at a doctor's office sharing the same information: one using medical terminology and one using simpler, jargon-free language. Survey participants were asked which doctor they preferred, to describe each doctor, and to explain why they believe that doctors may use medical terminology. Common descriptive themes for the jargon-using doctor included that this doctor caused confusion, was too technical, and was uncaring, while the doctor who spoke without jargon was perceived as a good communicator, caring/empathetic, and approachable. Respondents perceived a range of reasons why doctors use jargon, from not recognizing they are using words that are not understood to trying to make themselves feel more important. Overall, 91% of survey respondents preferred the doctor who communicated without medical jargon.

Likelihood of Craniofacial Injury and Hospitalization with Alcohol Use While Skateboarding and Scootering.

Study Design: We designed a cross-sectional epidemiologic study to evaluate the influence of substance use on craniofacial injuries in a population of skateboard and scooter users. Objective: The primary outcome of our study was craniofacial injury. The secondary outcome was hospitalization. Methods: We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2019, to December 31, 2020, in the United States. Patients were included in our study if they were evaluated in the emergency department (ED) for a skateboard- or scooter-related injury. Results: There were over 5396 total patients who presented to a NEISS-participating ED after skateboard- or scooter- related trauma during the study period. There were 1136 patients with a craniofacial injury (primary endpoint), and patients under the influence of alcohol or drugs had greater odds of experiencing a craniofacial injury than those not under the influence (odds ratio [OR]: 4.16, 95% confidence interval [CI]: 3.24-5.32, P < .0001). Four hundred-thirty patients were hospitalized (secondary endpoint), and patients under the influence had greater odds of being hospitalized than those not under the influence (OR: 2.83, 95% CI: 2.04-3.91, P < .0001). Conclusions: Alcohol and drug use while skateboarding or scootering drastically increases the likelihood of craniofacial injury and subsequent hospitalization and should be avoided whenever possible. The importance of wearing a helmet while operating these devices cannot be overstated.

Accuracy in Patient Understanding of Common Medical Phrases.

Importance: Despite acknowledging that medical jargon should be avoided, health care practitioners frequently use it when communicating with patients. Objective: To characterize the understanding of common medical jargon terms by surveying a cross section of the general public and studying phrases that have established meanings in regular usage but different meanings in a medical context (eg, negative and positive test results). Design, Setting, and Participants: In this cross-sectional study, participants indicated their understanding of phrases that may have different meanings in medicine than in colloquial English via a mix of short answer and multiple choice questions. Several questions included paired phrases to assess for differences in understanding with or without jargon. Volunteers were recruited at the 2021 Minnesota State Fair near St Paul, Minnesota. An electronic survey was given to a volunteer sample of 215 adults (>18 years) who did not work or train to work in the medical field and spoke and read English. Exposures: Completing a written or verbal survey. Main Outcomes and Measures: The main outcome was an accurate understanding of the medical terminology. Free-text responses were coded by 2 researchers for comprehension. Secondary outcomes looked for associations between volunteer demographics and understanding. Results: The 215 respondents (135 [63%] female; mean [SD] age, 42 [17] years) demonstrated a varied ability to interpret medical jargon phrases. For example, most participants (207 [96%]) knew that negative cancer screening results meant they did not have cancer, but fewer participants (143 [79%]) knew that the phrase "your tumor is progressing" was bad news, or that positive lymph nodes meant the cancer had spread (170 [67%]). While most (171 [80%]) recognized that an unremarkable chest radiography was good news, only 44 participants (21%) correctly understood that a clinician saying their radiography was impressive was generally bad news. In each of the paired phrases comparing jargon vs nonjargon approaches, the nonjargon phrase was understood significantly better (P < .001). Conclusions and Relevance: These findings suggest that several common phrases are misunderstood when used in a medical setting, with the interpreted meaning frequently the exact opposite of what is intended.

Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols.

PURPOSE: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies. METHODS: A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal. RESULTS: Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as "good response" (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs. CONCLUSION: While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.

Long-term Follow-up of Patients With Cerebral Palsy Undergoing Catheterizable Channel Creation Without Concurrent Bladder Augmentation.

OBJECTIVE: To characterize long-term outcomes for adults with cerebral palsy who have undergone catheterizable channel creation without concurrent bladder augmentation. METHODS: Retrospective review was conducted of patients who underwent catheterizable channel creation without augmentation by the senior author. Variables of interest included development of de novo neurogenic detrusor overactivity, change in continence, escalation in therapy, and upper tract changes. Descriptive statistics were conducted using t-tests and chi-squared tests as appropriate. RESULTS: Nine patients were followed for an average of 70 months. Prior to surgery two patients were on regular clean intermittent catheterization (CIC), six were not on CIC, and one was on occasional CIC. Patients not on CIC preoperatively were more likely to develop de novo neurogenic detrusor overactivity (83% vs 0%, P = .02), and have statistically significant decreases in average compliance (P = .04 vs P = .31). They were also more likely to require escalation in bladder therapy (83% vs 50%) and have worsening of incontinence (67% vs 0%), though these did not reach statistical significance (P = .34, 0.1). Five patients underwent repeat urodynamics an average of 46 months after initial postoperative study because of persistent urgency - 4 of 5 had stable urodynamic findings and one demonstrated >50% reduction in compliance and capacity. CONCLUSION: Adults with cerebral palsy who are not on CIC prior to creation of a catheterizable channel are at high risk for development of de novo neurogenic detrusor overactivity and decrease in bladder compliance. Prophylactic augmentation should be considered in this group.

What's in a name? Laypeople's understanding of medical roles and titles.

BACKGROUND: Physicians regularly use jargon in patient communication, which can lead to confusion and misunderstanding. OBJECTIVE: To assess the general public's understanding of names and roles of medical specialties and job seniority titles. DESIGNS: Volunteer participants completed an electronic survey, filling-in-the-blanks for 14 medical specialties (e.g., "pediatricians are doctors who take care of _____"), and ranked physician titles in order of experience (medical student, intern, senior resident, fellow, attending). SETTING: The 2021 Minnesota State Fair. PARTICIPANTS: Volunteers >18 years old without medical or nursing training. MAIN OUTCOME AND MEASURES: We summarized responses with descriptive statistics. Two researchers coded open-ended answers as correct, partially correct, or incorrect, with a third researcher for coding discrepancies. RESULTS: Two hundred and four participants completed the survey (55% female; mean age 43; 67% of respondents with a bachelor's degree or higher). Of 14 medical specialties listed on the survey, respondents most accurately identified dermatologists (94%) and cardiologists (93%). Six specialties were understood by less than half of the respondents: neonatologists (48%), pulmonologists (43%), hospitalists (31%), intensivists (29%), internists (21%), and nephrologists (20%). Twelve percent of participants correctly identified medical roles in rank order. Most participants (74%) correctly identified medical students as the least experienced. Senior residents were most often identified as the most experienced (44%), with just 27% of respondents correctly placing the attending there. We conclude that medical professionals should recognize that titles are a common source of misunderstanding among the general public and should describe their role when introducing themselves to minimize confusion.

Children in Boxing and Martial Arts Should Be Better Guarded From Facial Injuries.

Study Design: Cross-sectional study. Objective: Childhood participation in boxing and martial arts has increased over the past decade, and these activities are well-known causes of traumatic injury. We hypothesized that the face is frequently injured in the setting of pediatric boxing and martial arts trauma in the United States and that there are identifiable injury patterns. Methods: We performed a cross-sectional study of consecutive pediatric patients in the National Electronic Injury Surveillance System (NEISS) from January 1, 2010 to December 31, 2019. Patients were included in our study if they were younger than 18 years of age and evaluated in the emergency department (ED) after boxing or martial arts trauma. Primary outcome was facial injury. Other variables of interest include age, sex, ED disposition, type and location of injury. Descriptive and univariate statistics of the primary outcome were computed with these variables. Results: There were 4,978 total pediatric patients injured due to boxing and martial arts trauma reported by NEISS-participating EDs during the study period, and 264 patients experienced injury to the face (264/4978; 5.3%). Over 20% (n = 60) of reported facial injuries were fractures; the most fractured structure was the nose (42/60; 70), orbit (11/60; 18.3%), and mandible (6/60; 10%). Almost 20% (11/60%) of pediatric facial fractures due to boxing and martial arts trauma involved fighting a family member or friend, and a punch was the most common mode of fracture (42/58; 72.4%). Conclusions: Facial injuries comprise about 5% of injuries after boxing and martial arts trauma and 22% of these facial injuries are fractures. If children choose to participate, parents, coaches, trainers, officials, and community leaders should make the greatest effort possible to minimize risk, including the mandatory use of head and face protective gear and elimination of training fighting, or "sparring."

Interactions between physical activity and type of cancer treatment received on associations with psychosocial outcomes among gynecologic cancer survivors.

OBJECTIVE: Physical activity is associated with improved cancer outcomes; however, it is unclear which patients may benefit most from increased physical activity. We evaluated whether associations between meeting the American Cancer Society (ACS) physical activity recommendations and psychosocial outcomes in gynecologic cancer survivors varied by type of treatments received. METHODS: We recruited English-speaking adult gynecologic cancer patients from an academic gynecologic oncology practice to participate in a prospective cohort study. Participants completed a survey at study entry regarding their psychosocial health-including distress, depression, anxiety, post-traumatic stress disorder, and quality of life (QoL)-and physical activity. Multivariate linear regression models for each psychosocial outcome tested for interactions between physical activity and each effect modifier (receipt of chemotherapy, radiation therapy, and/or minimally invasive surgery), adjusted for age, pain, body mass index, primary cancer diagnosis, cancer stage, time since diagnosis, and annual household income. RESULTS: Among a total of 362 participants, 213 (59%) met ACS physical activity recommendations. We found evidence of interactions between physical activity and receipt of chemotherapy for depression, anxiety, and QoL scores; those who had received chemotherapy had a stronger association between physical activity and these psychosocial outcomes, compared to those who had not. We found no evidence of interactions between physical activity and receipt of radiation therapy or minimally invasive surgery for any of the outcomes. CONCLUSIONS: Gynecologic cancer survivors who received chemotherapy had significant associations between psychosocial health and physical activity, suggesting they may derive greatest benefit from prescribed exercise.

The Evolution of Retzius-Sparing Robot-Assisted Laparoscopic Prostatectomy: An Idea, Development, Evolution, Assessment, and Long-Term Study Perspective.

Purpose: The Retzius-sparing (RS) approach represents an important surgical innovation in how robot-assisted laparoscopic prostatectomy (RALP) is performed. The aim of this study was to examine to what extent its development has followed the idea, development, evolution, assessment, and long-term study (IDEAL) recommendations. Materials and Methods: We conducted a comprehensive literature search for studies up to the 18th of March 2021. Abstracted data points included authorship, year of publication, study design, reported endpoints, and length of follow-up. We mapped each study to the five IDEAL stages of surgical innovation using published criteria. Results: Of 415 references, 118 were included in our analysis. Five academic centers authored >50% of all study reports, with the groups from Seoul (24; 20.3%), Milan (15; 12.7%), and Ninjang (10; 8.5%) being the main contributors. Approximately 40% of studies (50/118) were reported as full-text publications. Most of the reports mapped to retrospective studies (97/118; 82.2%) with approximately one-third (31/97; 32.0%) reporting the use of prospectively collected data. Cumulatively, 17,974 were reported on RS-RALP. Of those, 13,929 were unique cases. Approximately 23% of cases were reported in multiple publications (4045/17,974). We mapped 2, 12, and 3 studies to the idea, assessment, and long-term study stages, respectively, and no study to the development and evaluation stages. Conclusions: Few reported studies followed the IDEAL stages for surgical innovation; none addressed the stages of development and evaluation. Future systematic prospectively planned assessments would be helpful to refine the approach and address issues related to the surgical learning curve.

Say What? Quantifying and Classifying Jargon Use During Inpatient Rounds.

BACKGROUND: Although plain language is recognized as essential for effective communication, research reveals that medical providers regularly use jargon terminology that may be misunderstood by patients. Little is known, however, about the types and frequency of jargon used in the pediatric inpatient setting. We aimed to quantify jargon use by medical team members during inpatient family-centered rounds (FCRs) and to identify the most common categories of jargon used. METHODS: One of 3 trained medical students audited FCRs on a general pediatric service once weekly for 12 weeks, recording and categorizing jargon used with a published classification framework. Jargon usage was classified by category and quantified by using descriptive statistics. Rates were calculated by patient encounter and per minute. Feedback was provided to rounding teams after each observation. RESULTS: During 70 observed FCR patient encounters, there were a total of 443 jargon words or phrases spoken, of which 309 (70%) were not explicitly defined to the patient or family by the health care provider team. The mean number of undefined jargon words or phrases used per patient was 4.3 (±1.7), with a mean of 0.4 (±0.1) uses of undefined jargon per minute. The most common categories of undefined jargon used include technical terminology (eg, bronchiolitis), medical vernacular (eg, cultures), and abbreviations and acronyms (eg, NPO for "nothing by mouth") at 34%, 30%, and 17%, respectively. CONCLUSIONS: Undefined medical jargon was used frequently by health care providers during pediatric FCRs. We found it was feasible to measure provider jargon use and to use a jargon classification scheme to provide real-time, concrete feedback.

The associations between physical activity, neuropathy symptoms and health-related quality of life among gynecologic cancer survivors.

OBJECTIVE: Physical activity may mitigate the effects of cancer treatment. We sought to evaluate the association between self-reported physical activity, neuropathy symptomatology, and emotional health in gynecologic cancer survivors. METHODS: Patients were recruited from an academic gynecologic oncology practice to a prospective cohort study. Participants completed semiannual surveys on quality of life (QOL), neuropathy symptoms, depression, distress, and health behaviors. Abstracted clinical data included cancer type, FIGO stage at diagnosis and treatments received (chemotherapy, surgery, radiation). Physical activity [no: moderate physical activity <150 min/week, yes: ≥150 min/week] and neuropathy symptomatology [high (FACT/GOG-Ntx ≥11; upper quartile); low (<11)] were dichotomized. Linear regression models assessed the associations between physical activity, neuropathy and psychosocial outcomes. RESULTS: A total of 194 participants were included in this analysis. We identified significant interactions between physical activity and neuropathy in the depression (p = 0.0006) and QOL (p = 0.007) models. Greater physical activity and lower neuropathy scores were independently associated with fewer depressive symptoms (p = 0.02 and p < 0.0001, respectively) and greater QOL (p = 0.005 and p < 0.0001). Low neuropathy scores were associated with lower distress (p < 0.0001). Women with high neuropathy scores had larger beneficial associations between being physically active and depression and QOL. In the distress model, interaction between neuropathy and physical activity was suggested (p = 0.05). CONCLUSIONS: Physical activity was associated with favorable psychosocial outcomes in gynecologic cancer survivors, most notably among those with worse neuropathy. These data suggest prescriptive exercise should be evaluated as a means of mitigating cancer-associated neuropathies and their effect on emotional health.