Dietary Phosphate Educational Materials for Pediatric Chronic Kidney Disease: Are Confused Messages Reducing Their Impact?

OBJECTIVE: This study aimed to review the quality and content of phosphate educational materials used in pediatric chronic kidney disease. METHODS: The quality of text-based (TB) pediatric phosphate educational materials was assessed using validated instruments for health literacy demands (Suitability Assessment of Materials, Patient Education Material Assessment Tool [PEMAT-P]) readability (Flesch Reading Ease, and Flesch-Kincaid Grade Level). Codes were inductively derived to analyse format, appearance, target audience, resource type, and content, aiming for intercoder reliability > 80%. The content was compared to Pediatric Renal Nutrition Taskforce (PRNT) recommendations. RESULTS: Sixty-five phosphate educational materials were obtained; 37 were pediatric-focused, including 28 TB. Thirty-two percent of TB materials were directed at caregivers, 25% at children, and 43% were unspecified. Most (75%) included a production date, with 75% produced >2 years ago. The median Flesch Reading Easetest score was 68.2 (interquartile range [IQR] 61.1-75.3) and Flesch-Kincaid Grade Level was 5.6 (IQR 4.5-7.7). Using Suitability Assessment of Materials, 54% rated "superior" (≥70), 38% rated "adequate" (40-69), and 8% rated "not suitable" (≤39). Low-scoring materials lacked a summary (12%), cover graphics (35%), or included irrelevant illustrations (50%). Patient Education Material Assessment Tool-P scores were 70% (IQR 50-82) for understandability and 50% (IQR 33-67) for actionability. An intercoder reliability of 87% was achieved. Over half of limited foods are in agreement with PRNT (including 89% suggesting avoiding phosphate additives). Recommendations conflicting with PRNT included reducing legumes and whole grains. Over a third contained inaccuracies, and over two-thirds included no practical advice. CONCLUSIONS: TB pediatric phosphate educational materials are pitched at an appropriate level for caregivers, but this may be too high for children under 10 years. The inclusion of relevant illustrations may improve this. Three-quarters of materials scored low for actionability. The advice does not always align with the PRNT, which (together with the inaccuracies reported) could result in conflicting messages to patients and their families.

Optimizing Readability of Patient-Facing Hand Surgery Education Materials Using Chat Generative Pretrained Transformer (ChatGPT) 3.5.

PURPOSE: To address patient health literacy, the American Medical Association and the National Institutes of Health recommend that readability of patient education materials should not exceed an eighth grade reading level. However, patient-facing materials often remain above the recommended average reading level. Current online calculators provide readability scores; however, they lack the ability to provide text-specific feedback, which may streamline the process of simplifying patient materials. The purpose of this study was to evaluate Chat Generative Pretrained Transformer (ChatGPT) 3.5 as a tool for optimizing patient-facing hand surgery education materials through reading level analysis and simplification. METHODS: The readability of 18 patient-facing hand surgery education materials was compared by a traditional online calculator for reading level and ChatGPT 3.5. The original excerpts were then entered into ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the same calculators. RESULTS: The readability scores for the original excerpts from the online calculator and ChatGPT 3.5 were similar. The simplified excerpts' scores were lower than the originals, with a mean of 7.28, less than the maximum recommended 8. CONCLUSIONS: The use of ChatGPT 3.5 for the purpose of simplification and readability analysis of patient-facing hand surgery materials is efficient and may help facilitate the conveyance of important health information. ChatGPT 3.5 rendered readability scores comparable with traditional readability calculators, in addition to excerpt-specific feedback. It was also able to simplify materials to the recommended grade levels. CLINICAL RELEVANCE: By confirming ChatGPT3.5's ability to assess and simplify patient education materials, this study offers a practical solution for potentially improving patient comprehension, engagement, and health outcomes in clinical settings.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Using the Clear Communication Index to Improve Materials for a Behavioral Intervention.

Ensuring that written materials used in behavioral interventions are clear is important to support behavior change. This study used the Clear Communication Index (CCI) to assess the original and revised versions of three types of written participant materials from the SIPsmartER intervention. Materials were revised based on original scoring. Scores for the entire index were significantly higher among revised versions than originals (57% versus 41%, p < 0.001); however, few revised materials (n = 2 of 53) achieved the benchmark of ≥90%. Handouts scored higher than worksheets and slide sets for both versions. The proportion of materials scored as having "a single main message" significantly increased between versions for worksheets (7% to 57%, p = 0.003) and slide sets (33% to 67%, p = 0.004). Across individual items, most significant improvements were in Core, with four-items related to the material having a single main message. Findings demonstrate that SIPsmartER's revised materials improved after CCI-informed edits. They advance the evidence and application of the CCI, suggesting it can be effectively used to support improvement in clarity of different types of written materials used in behavioral interventions. Implications for practical considerations of using the tool and suggestions for modifications for specific types of materials are presented.

What is the quality of drug safety information for patients: An analysis of REMS educational materials.

BACKGROUND: Poor-quality patient drug information has been identified as a major cause of preventable medication errors in the United States. The US Food and Drug Administration (FDA) has the authority to require marketing authorization holders of medicinal products to implement risk evaluation and mitigation strategies (REMS) to ensure that the benefits of a drug or biological product outweigh its risks. Aside from medication guides, no research has been conducted to assess the quality of patient-targeted REMS materials, including whether, and to what extent, patients find these materials understandable and actionable. PURPOSE: To describe the readability, understandability, and actionability of patient educational materials in currently approved REMS programs, and to highlight opportunities for improving both the quality and effectiveness of these important drug safety tools. METHODS: Seventy-seven REMS programs were identified from the FDA REMS database. We excluded medication guides (MGs) from our analysis because of the fact that there is a mandatory MG template. Based on this, we identified a total of 27 (non-MG) REMS patient materials on the FDA REMS website for analysis purposes. The materials were tested for readability using the Lexile Measure, the Gunning Fog Index, and Flesch Kincaid and then assessed using the Patient Education Materials Assessment Tool for printable materials, for understandability and actionability. RESULTS: Twenty-three of 77 (30%) REMS programs used educational materials to communicate serious risks to patients, yielding a total of 27 REMS patient materials for analysis. The median readability score for these materials was at a ninth-grade reading level or higher. While most (89%) of these patient education materials met established criteria for being understandable, less than half (49%) were deemed actionable. DISCUSSION: Currently approved REMS patient materials fell short in terms of recommended reading level, and over half did not meet recommended standards for actionability. Developers of these materials should apply plain language principles when design these materials to improve their readability and to assess both understandability and actionability in order to increase the effectiveness when distributed to patients.

Evaluating the readability and suitability of construction occupational safety and health materials designed for workers.

INTRODUCTION: Printed materials for training and hazard communication are an essential part of occupational safety and health programs, but must be understood by their intended audience. METHODS: Researchers collected 103 safety training handouts, brochures, and Safety Data Sheets and scored them for readability and suitability using four standard health communication instruments: the SMOG test, the Flesch-Kincaid Reading Ease Assessment, the SAM (Suitability Assessment of Materials), and CCI (the CDC Clear Communication Index). RESULTS: Some of the materials used unfamiliar and technical terms. The SAM and CCI checklists revealed several elements of design and layout known to facilitate communication and comprehension, but missing from most of the materials scored. CONCLUSION: Occupational safety and health professionals preparing curricula and handouts for distribution to workers should incorporate some form of readability and suitability assessment to help ensure their written materials are clear and comprehensible to all segments of their audience.

Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials.

OBJECTIVE: The research compared and contrasted hand-scoring and computerized methods of evaluating the grade level of patient education materials that are distributed at an academic medical center in east Tennessee and sought to determine if these materials adhered to the American Medical Association's (AMA's) recommended reading level of sixth grade. METHODS: Librarians at an academic medical center located in the heart of Appalachian Tennessee initiated the assessment of 150 of the most used printed patient education materials. Based on the Flesch-Kincaid (F-K) scoring rubric, 2 of the 150 documents were excluded from statistical comparisons due to the absence of text (images only). Researchers assessed the remaining 148 documents using the hand-scored Simple Measure of Gobbledygook (SMOG) method and the computerized F-K grade level method. For SMOG, 3 independent reviewers hand-scored each of the 150 documents. For F-K, documents were analyzed using Microsoft Word. Reading grade levels scores were entered into a database for statistical analysis. Inter-rater reliability was calculated using intra-class correlation coefficients (ICC). Paired t-tests were used to compare readability means. RESULTS: Acceptable inter-rater reliability was found for SMOG (ICC=0.95). For the 148 documents assessed, SMOG produced a significantly higher mean reading grade level (M=9.6, SD=1.3) than F-K (M=6.5, SD=1.3; p<0.001). Additionally, when using the SMOG method of assessment, 147 of the 148 documents (99.3%) scored above the AMA's recommended reading level of sixth grade. CONCLUSIONS: Computerized health literacy assessment tools, used by many national patient education material providers, might not be representative of the actual reading grade levels of patient education materials. This is problematic in regions like Appalachia because materials may not be comprehensible to the area's low-literacy patients. Medical librarians have the potential to advance their role in patient education to better serve their patient populations.

[Designing and evaluating therapeutic education tools for people living with HIV]. / Concevoir et évaluer des outils d'éducation thérapeutique pour les personnes vivant avec le VIH.

In the context of therapeutic education for people living with HIV in Africa, educational tools must be adapted to their living environment. OBJECTIVES: To describe the process of designing education tools for patients living with HIV and evaluate their use by African caregivers-educators. METHODS: An eight-step participatory and formative process was carried out to design educational tools. Twenty-one caregivers-educators from nine French-speaking African countries in three focus groups were interviewed on the way in which they used these tools. RESULTS: Fourteen people were trained in the process of designing the tools and training caregivers-educators in their use. Two toolkits were developed (adults and children/adolescents). The image folder was the tool most commonly used. Educators in all countries used tools to address self-care and psychosocial coping skills. The criteria for choosing the tools were linked to their attractiveness, ease of use, their adaptation to the patient's needs and characteristics, and the degree of mastery by the caregiver-educator. The tools helped to structure the education sessions. Brakes to their use were organizational and lack of experience or mastery. CONCLUSION: The participatory and formative approach enabled educators working with patients living with HIV in French-speaking Africa to appropriate the tools. Training was a crucial step in enabling caregiver-educators to master and disseminate the tools, and design new tools.

Health Literacy Demand of Printed Lifestyle Patient Information Materials Aimed at People With Chronic Kidney Disease: Are Materials Easy to Understand and Act On and Do They Use Meaningful Visual Aids?

People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated "not suitable" on SAM and fewer than half (n = 11, 42%) were rated "superior." PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing.

Sense and readability: participant information sheets for research studies.

BACKGROUND: Informed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11-12 years old. AIMS: To investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment. Method: We obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test. RESULTS: Information sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15-16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment. CONCLUSIONS: Information sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails.

Training model for laparoscopic Heller and Dor fundoplication: a tool for laparoscopic skills training and assessment-construct validity using the GOALS score.

BACKGROUND: Laparoscopic training demands practice. The transfer of laparoscopic skills from training models to real surgical procedures has been proven. The global operative assessment of laparoscopic skills (GOALS) score is a 5-item global rating scale developed to evaluate laparoscopic skills by direct observation. This scale has been used to demonstrate construct validity of several laparoscopic training models. Here, we present a low-cost model of laparoscopic Heller-Dor for advanced laparoscopic training. The aim of this study was to determine the capability of a training model for laparoscopic Heller-Dor to discriminate between different levels of laparoscopic expertise. METHODS: The performance of two groups with different levels of expertise, novices (<30 laparoscopic procedures PGY1-2) and experts (>300 laparoscopic procedures PGY4-5) was assessed. All participants were instructed to perform two tasks (esophageal myotomy and fundoplication). All the performances were recorded in a digital format. A laparoscopic expert who was blinded to subject's identity evaluated the recordings using the GOALS score. Autonomy, one of the five items of GOALS, was removed since the evaluator and the trainee did not have interaction. The time required to finish each task was also recorded. Performance was compared using the Mann-Whitney U test (p < 0.05 was significant). RESULTS: Twenty subjects were evaluated: ten in each group, using the GOALS score. The mean total GOALS score for novices was 7.5 points (SD: 1.64) and 13.9 points (SD: 1.66) for experts (p < 0.05).The expert group was superior in each domain of the GOALS score compared to novices: depth perception (mean: 3.3 vs 2 p < 0.05), bimanual dexterity (mean 3.4 vs 2.1 p < 0.05), efficiency (mean 3.4 vs 1.7 p < 0.05) and tissue handling (mean 3.6 vs 1.7 p < 0.05). With regard to time, experts were superior in task 1 (mean 9.7 vs 14.9 min p < 0.05) and task 2 (mean 24 vs 47.1 min p < 0.05) compared to novices. CONCLUSIONS: The laparoscopic Heller-Dor training model has construct validity. The model may be used as a tool for training of the surgical resident.