Readability and Quality of Online Patient Education Material on Websites of Breast Imaging Centers.

OBJECTIVES: The purpose of this study was to assess the readability and quality of patient information regarding mammography, tomosynthesis, and breast density on the websites of ACR-designated mammography Breast Imaging Centers of Excellence (BICOEs) in the United States. MATERIALS AND METHODS: In this institutional review board-exempt study, websites of mammography BICOEs were identified by state. Websites were assessed for presence of patient education material on screening mammography, tomosynthesis, and breast density. This material was then assessed for readability using five well-established readability metrics (Flesch-Kincaid Reading Ease Index, Flesch-Kincaid Grade Level, Gunning-Fog Score, Coleman-Liau Index, and Simple Measure of Gobbledygook Index) and for quality using the DISCERN instrument. RESULTS: We identified 1,482 BICOE centers, of which 1,451 (98%) had websites; 79% (1,156 of 1,451) of websites had information on screening mammography, 45% (657 of 1,451) on tomosynthesis, and 16% (228 of 1,451) on breast density. Readability analysis showed that the overall average grade level of patient information was 12.4. Average readability grade levels by tested indexes were Flesch-Kincaid Grade Level of 11.5, Gunning-Fog Score of 14.1, Coleman-Liau Index of 14.1, and Simple Measure of Gobbledygook Index of 10.9. The average Flesch-Kincaid Reading Ease score was 45, with 0 being the most difficult and 100 being the easiest text to read. The overall DISCERN score nationally was 2.61 of 5 (with 5 representing the highest quality). CONCLUSIONS: Although most BICOEs have patient education material on their websites regarding mammography and some have information regarding tomosynthesis and breast density, the average readability grade level of this material is more than double the nationally recommended readability grade level of 6 for health care information. Additionally, the overall quality of this material is relatively low per established quality metrics.

Administration of Tumescence in Pediatric Burn Patients Causes Significant Hypertension.

The effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33-3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.

Ghrelin Receptor Agonist Rescues Excess Neonatal Mortality in a Prader-Willi Syndrome Mouse Model.

In the current study, we sought to determine the significance of the ghrelin system in Prader-Willi Syndrome (PWS). PWS is characterized by hypotonia and difficulty feeding in neonates and hyperphagia and obesity beginning later in childhood. Other features include low GH, neonatal hypoglycemia, hypogonadism, and accelerated mortality. Although the hyperphagia and obesity in PWS have been attributed to elevated levels of the orexigenic hormone ghrelin, this link has never been firmly established, nor have ghrelin's potentially protective actions to increase GH secretion, blood glucose, and survival been investigated in a PWS context. In the current study, we show that placing Snord116del mice modeling PWS on ghrelin-deficient or ghrelin receptor [GH secretagogue receptor (GHSR)]-deficient backgrounds does not impact their characteristically reduced body weight, lower plasma IGF-1, delayed sexual maturation, or increased mortality in the period prior to weaning. However, blood glucose was further reduced in male Snord116del pups on a ghrelin-deficient background, and percentage body weight gain and percentage fat mass were further reduced in male Snord116del pups on a GHSR-deficient background. Strikingly, 2 weeks of daily administration of the GHSR agonist HM01 to Snord116del neonates markedly improved survival, resulting in a nearly complete rescue of the excess mortality owing to loss of the paternal Snord116 gene. These data support further exploration of the therapeutic potential of GHSR agonist administration in limiting PWS mortality, especially during the period characterized by failure to thrive.