[Digital educational materials on culinary skills as a health promotion strategy in Primary Health Care]. / Materiais educativos digitais sobre habilidades culinárias como estratégia de promoção de saúde na Atenção Primária.

This study aims to report on the development and validation of digital educational materials based on the dimensions of home cooking skills (HCS) assessed on a scale destined for PHC professionals, following the recommendations of The Dietary Guidelines for the Brazilian Population and on The Food and Nutrition Education Framework (FNE) for Public Policies. Five videos and graphic materials were developed with proposals for activities to develop HCS and encourage its implementation in actions and guidelines in the community and in professional care. The content of the materials was evaluated by experts using the Two-Round Delphi-based technique and statistical analyses for evidence of consensus. Specialists presented comments to improve the products and their applicability. The materials presented decoded language and playful illustrations with characters representative of the target population. Evidence of satisfactory content validity was presented and can be used in permanent education actions, seeking the qualification of the workforce and in FNE actions within the scope of the law. The graphic materials make it possible to associate the content of the videos with practice in contexts consistent with the reality of the individuals.

Este estudo visa reportar desenvolvimento e validação de materiais educativos digitais baseados nas dimensões de habilidades culinárias domésticas (HCD) avaliadas por escala destinada aos profissionais da APS, nas recomendações do Guia Alimentar Para a População Brasileira e no Marco de Educação Alimentar e Nutricional (EAN) para Políticas Públicas. Foram desenvolvidos 5 vídeos e materiais gráficos com propostas de atividades para desenvolvimento de HCD e estímulo à sua implementação em ações e orientações junto à comunidade e em atendimentos profissionais. O conteúdo dos materiais foi avaliado por especialistas utilizando técnica Delphi de 2 rounds e análises estatísticas para evidência de consenso. Especialistas proferiram comentários para aprimoramento dos produtos e sua aplicabilidade. Os materiais apresentaram linguagem decodificada, ilustrações lúdicas, com personagens representativos da população-alvo. Apresentaram evidência de validade de conteúdo satisfatória e podem ser utilizados em ações de educação permanente, visando a qualificação da força de trabalho, e em ações de EAN junto aos sujeitos de direito. Os materiais gráficos possibilitam associar o conteúdo dos vídeos à prática, em contextos condizentes com a realidade dos sujeitos.

EurOP2E - the European Open Platform for Prescribing Education, a consensus study among clinical pharmacology and therapeutics teachers.

PURPOSE: Sharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers. METHODS: CPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting. RESULTS: Data from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources. CONCLUSION: Key challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system.

Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study.

OBJECTIVES: To examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation. METHODS: A prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped. RESULTS: Audio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to "positive pressure ventilation" (p<0.01). CONCLUSIONS: In this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.

The Smart Class Teaching Module for Rehabilitation Medicine English Education in China.

BACKGROUND Learning medical English is particularly challenging for non-native English-speaking medical students. The Smart Class teaching module is a new online teaching module for rehabilitation-related medical English, the efficacy of which has yet to be established in the literature. Gender differences should also not be ignored in our study, taking into account the proven performance differences between males and females in language learning. MATERIAL AND METHODS First-year physiotherapy students in Grade 2018 and Grade 2019 at Guangzhou Medical University were recruited to participate in this study. Grade 2019, as the experimental group, completed the Smart Class teaching module, while Grade 2018, as the control group, completed the Traditional Class teaching module. The efficacy of both modules was assessed objectively using the students' medical English exam scores and subjectively using the students' responses to a questionnaire. RESULTS In total, 242 questionnaires were distributed, and 210 valid questionnaires were returned, of which 119 were from the Smart Class teaching module group and 91 were from the Traditional Class teaching module group. There was no statistically significant difference between the medical English exam scores of the 2 groups (P=0.324). However, the subjective assessment revealed that the students experienced a significantly greater burden from the workload in the Smart Class teaching module group (P<0.001). CONCLUSIONS We found both the Smart Class teaching module and the Traditional Class teaching module achieved similar teaching outcomes. Therefore, the former represents a viable alternative teaching option for situations where traditional class teaching is not possible.

Assessment of the Readability, Availability, and Quality of Online Patient Education Materials Regarding Uveitis Medications.

Purpose: To assess the availability, quality, and readability of online patient education materials regarding uveitis medications.Methods: The top 10 Google search results for 10 commonly prescribed uveitis medications (prednisone, azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, chlorambucil, cyclophosphamide, adalimumab, and infliximab) were analyzed for readability and accountability. Readability was assessed with the Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Simple Measure of Gobbledygook Index, and Coleman Liau Index. JAMA benchmarks were used to assign websites accountability scores. Statistical analysis was performed with two-tailed t-tests.Results: Of 100 search results, none complied with the recommended sixth-grade reading level across all readability formulas. Only one website satisfied all 4 JAMA benchmarks, two websites were able to satisfy three benchmarks, and the remainder achieved two or less.Conclusions: Online information regarding uveitis medications lacks accountability and is not written at an appropriate level for the average patient.

Comparison of the effect of educational software and booklet on anxiety and pain during labour: a randomised controlled clinical trial.

This randomised clinical trial was conducted on 153 pregnant women. Participants were assigned into two intervention groups including educational software and an educational booklet and a control group through block randomisation. A training session was implemented for the intervention groups at 30-36 weeks and they were taught how to use the educational methods. Participants were followed-up until the childbirth time and the severity of pain was measured at four stage of cervical dilatation (4, 6, 8 and 10 cm) by Visual Analogue Scale (VAS). Spielberger State-Trait Anxiety Inventory was completed at 4-5 cm cervical dilatation. There was no significant difference between groups in terms of the labour pain intensity (p > .05). After intervention, mean (SD) of state anxiety score was 38.7 (2.6) in educational software group, 44.3 (7.4) in educational booklet group and 63.3 (8.2) in control group. Also, mean (SD) of trait anxiety score was 47.4 (2.7) in educational software group, 47.2 (2.4) in educational booklet group and 61.8 (3.9) in control group. The mean state and trait anxiety scores in both intervention groups were significantly lower than control group (p < .001). Both intervention groups were effective in reducing anxiety. Thus, these educational methods should be recommended for pregnant women in clinical practices.IMPACT STATEMENTWhat is already known on this subject? Childbirth is one of the most important crises in women's life, in which stress and other forms of emotional distress such as anxiety are likely to occur during it. Safe practices and effective interventions can be offered to pregnant women to tolerate the labour pain and reduce anxiety during labour.What do the results of this study add? There was no statistically significant difference between two intervention groups (educational software and educational booklet groups) and control group in terms of the pain intensity at the cervical dilatation of 4, 6, 8 and 10 cm. But the state and trait anxiety in both groups (educational software and educational booklet groups) was significantly less than the control group. Also, the anxiety level was significantly lower in the educational software group than the educational booklet group.What are the implications of these findings for clinical practice and/or future research? Educational software and booklet with educational content about position modification during pregnancy, stretching exercises, breathing techniques and exercises, relaxation and lower back massage for reducing anxiety should be recommended for pregnant women in clinical practices.

Patient Education in Neurosurgery: Part 1 of a Systematic Review.

BACKGROUND: Patient education has become increasingly important in neurosurgery. However, little is known regarding how to comprehensively educate neurosurgical patients. In the first part of a 2-part systematic review, we identify baseline patient understanding and educational needs, examine existing patient education materials, and characterize shortcomings in neurosurgical patient education practices. Our findings may guide neurosurgeons, departments, and professional associations in improving communication with patients. METHODS: A 2-part systematic review was conducted using the PubMed, Embase, and Scopus databases. Titles and abstracts were read and selected for full text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. RESULTS: Of 1617 resultant articles, 41 were included. Patient comprehension was low. Patient informational needs differed across patients and between patients and neurosurgeons. Patient informational needs were often unmet, promoting dissatisfaction. Written educational materials from government agencies, professional associations, neurosurgery departments, neurosurgeons, or widely read Web sites were written at a reading level above the recommended reading level, with complex topics written at a higher level. Information found on hospital and university Web sites was poor quality because of self-marketing and lack of reference to peer-reviewed literature. Educational videos created by universities and hospitals were poor quality. CONCLUSIONS: Current in-clinic discussions and education materials show shortcomings, promoting poor comprehension. Neurosurgeons, departments, and professional organizations can act to improve the effectiveness of patient education initiatives. This policy will better inform patients, increase rapport between neurosurgeons and patients, and improve patient decision making and satisfaction.

Quality assessment of cancer patient education materials: the current state of systemic therapy patient education in fourteen cancer centres across Ontario, Canada.

PURPOSE: Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials. METHODS: A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices. RESULTS: A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices. CONCLUSION: Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives.

Animated Guide to Represent a Novel Means of Gut-Brain Axis Communication.

Novel scientific concepts must be made understandable to allow their further development, highlighting the need for better communication of abstract ideas that these discoveries are built upon. This project focused on visually communicating the discovery of microbiome-derived molecules that play a major role in microbiome-gut-brain axis communication through multimedia learning.A 4-min animated video that was segmented and used a combination of 2D and 3D models was created. It communicated the important information about the process of discovering the molecules in mouse models, their production by bacteria and their potential implications for human health. The animation was then provided to a scientific audience, alongside a short-answer survey and a Likert scale, to assess how visual aspects accompanied with narration compare to learning and comprehension of the same content if it is read.The findings are based on the total of 15 participants, 9 of which were exposed to the information via animation (Group A) and 6 who were given information in a form of written narrative (Group B). It was found that Group A scored average M = 15 (out of 25) on the post assessment compared to Group B with an average of M = 7. Higher scores correlated with higher rating on questions about perceived understanding through animated media. Additionally, the animation scored higher on helpfulness in learning abstract ideas, especially having to do with structure and spatial navigation. This indicates that scientific abstract concepts that are likely comprehended are needed in order to make definite conclusions.

A Methodology for Visualising Growth and Development of the Human Temporal Bone.

This chapter presents a methodological framework which could be used to produce accurate anatomical 3D models and animations of the developing skull, with a focus on the temporal bone. Initial modelling is based on information from core texts and visual references, before optimising these models for use in interactive real-time applications. A series of 3D modelling and animation workflows typically used in computer games and animation industry were tested and compared. Workflows most suitable for the production of a 3D visualisation of the developing temporal bone were documented in detail and used to produce the final 3D models. 3D models of the developing temporal bone were then implemented in an interactive mobile application, which allowed users to explore the 3D models on their Android mobile device and use augmented reality to enhance real-world information. Results of tests conducted in this research suggest that 3D modelling workflows which mimic the processes occurring during development of the temporal bone are most suitable for producing realistic 3D models. Animation workflows tested in this research have all shown potential to produce morphing animations of the developing temporal bone. The significant time required to create deformation setups and animations themselves however suggests that using scripting to automate these workflows would increase their usability in projects with a limited timeframe.

Proposing Standards for Teaching Authentic Nursing Knowledge.

This article's purpose is to propose ideas about developing teaching standards for each of 4 learner levels that lead to 4 types of nursing practice. The learner levels and types of practice are undergraduate/basic practice, graduate/enhanced practice, doctor of nursing practice/translational practice, and research doctorate/knowledge development practice. Each learner level requires different content and different teaching strategies. Thus, teaching at each level requires different teaching standards. This article is written in separate parts. Each section develops necessary ideas to support a set of recommended teaching standards needed to teach authentic nursing theoretical thinking at each level of nursing education.

Guidance on Expedited Partner Therapy: A Content Analysis of Informational Materials for Providers, Pharmacists, Patients, and Partners.

BACKGROUND: The rates of sexually transmitted infections have steadily increased in the United States over the last 5 years. The Centers for Disease Control and Prevention has endorsed the use of expedited partner therapy (EPT) as an evidence-based practice to prevent chlamydial reinfection in index patients and lower barriers to treatment for partners. State health departments release guidance on EPT for providers, but it is unclear if information is available for other key stakeholders, for example, pharmacists, patients, and partners. The primary objective of this study was to conduct a review of state and territory health department websites to ascertain the availability, readability, utility, and content of EPT informational materials. METHODS: A content analysis of 84 EPT informational materials was conducted using validated tools to measure readability, adherence to design standards, and EPT content inclusion. Results were stratified for each target audience. RESULTS: Only 64% of states where EPT is allowable had informational materials available. The materials targeted providers (51.2%) and partners (35.7%). Little information targeted pharmacists (7.1%) or index patients (4.8%). The average reading level was 11th grade. Mean design score was 9.57 points of a possible 13 points. Most provider and pharmacist materials did not meet the content criteria; index and partner materials did not thoroughly describe cost of EPT, how to communicate with sex partners about EPT/chlamydia, or how to fill an EPT prescription. CONCLUSIONS: To better support the uptake of EPT, existing resources for EPT should be improved in their design, readability, content, and availability for all target audiences.

What Is a Good Teaching Video? Results of an Online International Survey.

STUDY OBJECTIVE: To analyze surgeon views on criteria for a good teaching video with the aim of determining guidelines. DESIGN: An online international survey using a self-developed questionnaire. SETTING: A French university tertiary care hospital. PATIENTS: Three hundred eighty-eight participants answered an online questionnaire (154 women [40.53%] and 226 men [59.47%]). INTERVENTIONS: A questionnaire on the criteria for a good quality teaching surgery video was developed by our team and communicated via an online link. MEASUREMENTS AND MAIN RESULTS: The responses of 388 respondents were analyzed and highlighted the pedagogical benefits of teaching videos. The video duration may vary according to the type of media or surgical procedure but should not exceed 10 to 15 minutes for complex procedures. Providing information on the surgical setup (body mass index of the patient, Trendelenburg position degree, pressure of pneumoperitoneum, etc.) is essential. Surgical videos should be reviewed and divided into clearly defined steps with continued access to the entire nonmodified video for reviewers and be accessible on both educational and open platforms. Patient consent and relevant information should be made available. Reviews should include "bad procedure" videos, which are highly appreciated, especially by young surgeons. CONCLUSION: The many advantages of the video format, including availability and rising popularity, provide an opportunity to reinforce and complement current surgical teaching. To optimize use of this surgical teaching tool, standardization, updating, and ease of access of surgical videos should be promoted.

The quality, understandability, readability, and popularity of online educational materials for heart murmur.

OBJECTIVE: Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur. METHODS: An Internet search was performed for "heart murmur" using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains' popularity and visibility. RESULTS: We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were "easy to understand". The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch-Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9). CONCLUSION: We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.

Readability of Online Neuro-Oncology-Related Patient Education Materials from Tertiary-Care Academic Centers.

BACKGROUND: The Internet has become a popular resource for patients to research diagnosed or suspected medical diseases. Medical institutions provide comprehensive online education resources about various conditions to the general public. The U.S. National Institutes of Health and American Medical Association recommend that patient education materials aimed at the general population should be written at or below eighth-grade reading level. The goal of this study is to assess the readability of patient education materials for central nervous system tumors across tertiary-care institutions. METHODS: Patient education materials were collected from National Cancer Institute designated cancer centers in October 2019. Materials were analyzed by Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score using Microsoft Office Word software. Subgroups were formed based on regions in the United States (Northeast, Southeast, Midwest, Southwest, and West) as well as diagnostic and treatment information. RESULTS: A total of 180 documents were collected across 50 institutions. Overall median FKGL was 12.5, and median FRE was 38.2. Median FKGL for diagnostic information was 11.6 and FRE was 43.0, whereas median FKGL for treatment information was 12.9 and median FRE was 34.3. No statistically significant differences were seen for both FKGL and FRE among geographic regions (P > 0.05). CONCLUSIONS: Online neuro-oncology patient education materials from tertiary institutions are written above recommended reading levels. Future efforts should be taken to improve the readability of brain tumor-specific patient education materials, particularly with information relating to treatment.

Online information on Crohn's disease in Chinese: an evaluation of its quality and readability.

To assess the quality and readability of patient-education information on Crohn's disease on the internet in China. METHODS: Baidu and Sogou were chosen as search engines, and the top 58 webpages on Crohn's disease meeting the inclusion criteria were evaluated. After the data were screened, the quality of information was assessed by two specialists using a simplified DISCERN system. Different levels of official Chinese-teaching materials were used to build a readability model to predict the readability of these information. RESULTS: Altogether 13 pieces of information were included in this study, all of which were derived from commercial webpages. The simplified DISCERN system found an excellent consistency in the Chinese literature, and Spearman's coefficient was 0.685, 0.556 and 0.607, respectively (P < 0.001), for publication reliability, treatment options and the total score. Most of the information lacked clear sources and conflicts of interest statements. The corresponding DISCERN scores were all below 2. In terms of treatment options, many webpages did not provide adequate information about the prognosis, possible side effects of treatment and risks of developing cancer. The scores of treatment-related DISCERN items were all below 2 as well. The webpages did not show enough readability. Altogether 84.6% of the information exceeded the middle-school readability level, and 69.2% exceeded the high-school level. CONCLUSIONS: The quality of patient-education information on Crohn's disease on the internet in China is worrisome, with poor readability, which should be addressed by the academic community.

Assessing the Understandability and Actionability of Online Neurosurgical Patient Education Materials.

BACKGROUND: Most Americans consult the Internet to address their health concerns. Limited health literacy among the public highlights the need for patient education Web sites to deliver understandable health information. We assessed the understandability and actionability of online neurosurgical patient education materials (PEMs) provided by the American Association of Neurological Surgeons (AANS) and MedlinePlus. METHODS: Articles on neurosurgical conditions and treatments listed on both the AANS site and MedlinePlus were analyzed. Two reviewers scored articles using 2 validated health literacy tools, the Centers for Disease Control and Prevention Clear Communication Index (CCI) and the Agency for Healthcare Research and Quality (AHRQ) Patient Education Materials Assessment Tool (PEMAT). These tools evaluate the quality of written health information and assess for content, organization, and actionability of PEMs. RESULTS: One hundred and thirty-eight articles were evaluated from the AANS (n = 61) and MedlinePlus (n = 77). The median CCI score for MedlinePlus and AANS articles was 68.9 (interquartile range [IQR], 62.5-81.3) and 56.3 [IQR, 46.7-73.7], respectively (P < 0.001). Only 1 article scored ≥90%, which is the CCI threshold for PEMs to be considered easy to read. Although the AANS and Medline performed similarly on the understandability component of the PEMAT (66.7 [IQR, 53.8-69.2] vs. 69.2 [IQR, 66.7-83.3], respectively; P < 0.001), significant differences were observed for the actionability section of the PEMAT (Medline 60 [IQR, 60-60] vs. AANS 0 [IQR, 0-60]; P < 0.001). Less than 13% of articles provided summaries, visual aids, and tangible tools to aid patient action. CONCLUSIONS: Neurosurgical online PEMs may be difficult to understand and potentially act as barriers for patients' engagement with health systems. There is a need to deliver patient-centered health information that effectively informs patients, aiding in meaningful health decision making.