Factors influencing patient understanding of information on radiology examinations.

PURPOSE: To determine which factors influence patient understanding of information documents on radiology examinations. MATERIALS AND METHODS: This is a randomized prospective study with 361 consecutive patients. Documents with information on 9 radiology exams were obtained ( www.radiologyinfo.org ). Three versions of each of these were written at low (below 7th grade), middle (8-12th grade), and high (college) reading grades. Before their scheduled radiology exam, patients were randomized to read one document. Their subjective and objective understanding of the information was assessed. Statistics including logistic regression used to assess relationships between demographic factors and document grade level and understanding. RESULTS: Twenty-eight percent (100/361) of patients completed the study. More females vs. males (85% vs. 66%) read their entire document (p = 0.042). Document grade level was not associated with understanding (p > 0.05). Correlation between college degrees and subjective understanding was positive (r = 0.234, p = 0.019). More females (74% vs. 54%, p = 0.047) and patients with college degrees (72% vs. 48%, p = 0.034) had higher objective understanding. Controlling for document grade level and demographics, patients with college degrees were more likely to have subjective understanding of at least half of the document (OR 7.97, 95% CI [1.24, 51.34], p = 0.029) and females were more likely to have higher objective understanding (OR 2.65, 95% CI [1.06, 6.62], p = 0.037). CONCLUSION: Patients with college degrees understood more on information documents. Females read more of the documents than males and had a higher objective understanding. Reading grade level did not affect understanding.

Estimated GFR and Incidence of Major Surgery: A Population-Based Cohort Study.

RATIONALE & OBJECTIVE: Kidney disease is associated with an increased risk for postoperative morbidity and mortality. However, the incidence of major surgery on a population level is unknown. We aimed to determine the incidence of major surgery by level of kidney function. STUDY DESIGN: Retrospective cohort study with entry from January 1, 2008, through December 31, 2009, and outcome surveillance from January 1, 2010, through December 31, 2016. SETTING & PARTICIPANTS: Population-based study using administrative health data from Alberta, Canada; adults with an outpatient serum creatinine measurement or receiving maintenance dialysis formed the study cohort. EXPOSURE: Participants were categorized into 6 estimated glomerular filtration rate (eGFR) categories: ≥60 (G1-G2), 45 to 59 (G3a), 30 to 44 (G3b), 15 to 29 (G4), and<15mL/min/1.73m2 with (G5D) and without (G5) dialysis. eGFR was examined as a time-varying exposure based on means of measurements within 3-month ascertainment periods throughout the study period. OUTCOME: Major surgery defined as surgery requiring admission to the hospital for at least 24 hours. ANALYTICAL APPROACH: Incidence rates (IRs) for overall major surgery were estimated using quasi-Poisson regression and adjusted for age, sex, income, location of residence, albuminuria, and Charlson comorbid conditions. Age- and sex-stratified IRs of 13 surgery subtypes were also estimated. RESULTS: 1,455,512 cohort participants were followed up for a median of 7.0 (IQR, 5.3) years, during which time 241,989 (16.6%) underwent a major surgery. Age and sex modified the relationship between eGFR and incidence of surgery. Men younger than 65 years receiving maintenance dialysis experienced the highest rates of major surgery, with an adjusted IR of 243.8 (95% CI, 179.8-330.6) per 1,000 person-years. There was a consistent trend of increasing surgery rates at lower eGFRs for most subtypes of surgery. LIMITATIONS: Outpatient preoperative serum creatinine measurement was necessary for inclusion and outpatient surgical procedures were not included. CONCLUSIONS: People with reduced eGFR have a significantly higher incidence of major surgery compared with those with normal eGFR, and age and sex modify this increased risk. This study informs our understanding of how surgical burden changes with differing levels of kidney function.

Assessing the readability of patient-targeted online information on musculoskeletal radiology procedures.

OBJECTIVE: To assess the readability of patient-targeted online information on musculoskeletal radiology procedures. METHODS: Eleven common musculoskeletal radiology procedures were queried in three online search engines (Google, Yahoo!, Bing). All unique patient-targeted websites were identified (n = 384) from the first three pages of search results. The reading grade level of each website was calculated using 6 separate validated metrics for readability assessment. Analysis of word and sentence complexity was also performed. Results were compared between academic vs. non-academic websites and between websites found on different pages of the search results. Statistics were performed using a t test. RESULTS: The mean reading grade level across all procedures was 10th-14th grade. Webpages for nerve block were written at a higher reading grade level on non-academic websites (p = 0.025). There was no difference in reading grade levels between academic and non-academic sources for all other procedures. There was no difference in reading grade levels between websites found on the first page of search results compared with the second and third pages. Across all websites, 16-22% of the words used had 3+ syllables and 31-43% of the words used had 6+ characters (complex words); 13-24% of the sentences used had 22+ words (complex sentences). CONCLUSION: Patient-targeted online information on musculoskeletal radiology procedures are written at the 10th-14th grade reading level, which is well beyond the AMA and NIH recommendation. Readability can be lowered by decreasing text complexity through limitation of high-syllable words and reduction in word and sentence length.

Interventional therapeutic procedures in the musculoskeletal system: an Italian Survey by the Italian College of Musculoskeletal Radiology.

PURPOSE: To perform an online survey among all members of the Italian College of Musculoskeletal Radiology to understand how therapeutic musculoskeletal procedures are performed in daily practice in Italy. METHODS: We administered an online survey to all 2405 members about the use of therapeutic musculoskeletal procedures in their institutions asking 16 different questions. Subgroup analysis was performed between general and orthopaedic hospitals with Mann-Whitney U and χ 2 statistics. RESULTS: A total of 129/2405 answers (5.4% of members) were included in our analysis. A median of 142.5 (25th-75th percentiles: 50-535.5; range 10-5000) therapeutic musculoskeletal procedures per single institution was performed in 2016. Arthropathic pain was the main indication. The most common procedures were joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy. Ultrasound-guided procedures were mainly performed in ultrasonography rooms (77.4%) rather than in dedicated interventional rooms (22.6%). Conversely, fluoroscopic procedures were performed almost with the same frequency in interventional radiology suites (52.4%) and in general radiology rooms (47.6%). In most institutions (72%), autologous blood or components were not used. The median number of therapeutic musculoskeletal procedures performed in orthopaedic hospitals was significantly higher than in general hospitals (P = 0.002), as well as for the use of autologous preparations (P = 0.004). CONCLUSION: Joint injection, bursal/tendon injection, and irrigation of calcific tendinopathy were the most common therapeutic musculoskeletal procedures, being arthropathic pain the main indication. The percentage of procedures and the use of autologous preparations were significantly higher in orthopaedic hospitals than in general hospitals.