Readability of Online Patient Education Materials for the 10 Most Common Hand Conditions.

Background Millions of individuals every day turn to the internet for assistance in understanding their hand conditions and potential treatments. While online educational resources appear abundant, there are concerns about whether resources meet the readability recommendations agreed upon by the American Medical Association (AMA) and the National Institutes of Health (NIH). Identifying educational resources that are readable for the majority of patients could improve a patient's understanding of their medical condition, subsequently improving their health outcomes. Methods The readability of the top five websites for the 10 most common hand conditions was examined using the Flesch-Kincaid (FK) analysis, comprising the FK reading ease and FK grade level. The FK reading ease score is an indicator of how difficult a text is to comprehend, while the FK grade level score is the grade level an individual reading a particular text would need to fully understand the text. Results The average FK reading ease was 56.00, which correlates with "fairly difficult (high school)". The average FK corresponded to an eighth-grade reading level, far above the sixth-grade reading level recommendation set by the AMA and NIH. Conclusion Patient education, satisfaction, and the patient-physician relationship can all be improved by providing patients with more readable educational materials. Our study shows there is an opportunity for drastic improvement in the readability of online educational materials. Guiding patients with effective search techniques, advocating for the creation of more readable materials, and having a better understanding of the health literacy barriers patients face will allow hand surgeons to provide more comprehensive care to patients.

Readability of Online Spanish Materials for Breast Reconstruction Using Deep Inferior Epigastric Perforator Flaps.

Background The internet has become an increasingly popular tool for patients to find information pertaining to medical procedures. Although the information is easily accessible, data shows that many online educational materials pertaining to surgical subspecialties are far above the average reading level in the United States. The aim of this study was to evaluate the English and Spanish online materials for the deep inferior epigastric perforator (DIEP) flap reconstruction procedure. Methods The first eight institutional or organizational websites that provided information on the DIEP procedure in English and Spanish were included. Each website was evaluated using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and either Simplified Measure of Gobbledygook (SMOG) for English websites or Spanish Orthographic Length (SOL) for Spanish websites. Results The English websites had a statistically lower CSAT score compared to the Spanish websites (p=0.006). However, Spanish websites had a statistically higher percentage of complex words compared to English sources (p<0.001). An analysis of reading grade levels through SMOG and SOL scores revealed that Spanish websites had statistically lower scores (p<0.001). There were no statistically significant differences in the understandability or actionability scores between the English and Spanish websites. Conclusions Online educational materials on the DIEP flap reconstruction procedure should be readable, understandable, actionable, and culturally sensitive. Our analysis revealed that improvements can be made in understandability and actionability on these websites. Plastic surgeons should be aware of what constitutes a great online educational resource and what online educational materials their patients will have access to.

Ureteral Metastasis From Prostate Cancer: A Report of Two Cases.

Prostate adenocarcinoma (PCa) is the second most common cause of cancer in men, but metastases to the ureter are exceedingly rare. Here, we present two cases with differing clinical symptoms and treatment courses but ultimately the same diagnosis. The two cases presented here had differing clinical presentations: one with lower urinary tract symptoms and the other with hydronephrosis. Systemic therapy with a luteinizing hormone-releasing hormone (LHrH) agonist appears to help with clinical outcomes in both cases reported here. Although such cases are extremely rare, consideration as a differential and early detection can impact a patient's clinical outcomes. For patients with PCa that present with obstructive urinary symptoms, there may be a clinical benefit to perform a thorough metastatic work-up for seeding to other parts of the urinary tract.

Dr. Newton Shaffer (1846-1928): Renowned Orthopedic Surgeon and Founder of the American Orthopaedic Association.

An unsung hero of American orthopedic surgery is the largely forgotten Dr. Newton Melman Shaffer (1846-1928). Upon graduating from medical school at New York University, Shaffer began his career training at the Hospital for the Ruptured and Crippled in 1867. Shaffer then went on to practice at St. Luke's Hospital and New York Orthopaedic Dispensary and Hospital where he became chief. Here, Shaffer made major contributions to the field in treating clubfoot and tuberculosis. He then declared orthopedics as a separate entity from general surgery at the 10th International Medical Congress. He helped start the American Orthopaedic Association to push for the recognition of American orthopedics to the international community. In 1900, Shaffer opened the first state-run hospital for underprivileged children requiring rehabilitation. During his career, Shaffer advocated for conservative orthopedic treatments, aided in the invention of medical devices, contributed largely to academic orthopedics, and successfully advocated for the inception of the field of orthopedic surgery.

A Rare Case of a Primary Cutaneous Collision Tumor Comprising Malignant Melanoma and Rhabdomyosarcoma.

This case reports a 35-year-old man who presented with a painful erythematous nodule on his right posterior calf. He first noticed this nodule several years ago and it often bled upon contact with clothing. An excisional biopsy of the skin lesion revealed two distinct populations of cells. One population of epithelioid cells stained positive for Mart-1, HMB45, and SOX-10, confirming the diagnosis of malignant melanoma. The second population of cells stained positive for desmin and calponin, confirming the diagnosis of sarcoma with muscular differentiation. Subsequently, these unusual findings led to the diagnosis of a collision tumor comprising malignant melanoma and rhabdomyosarcoma. Follow-up PET/CT and brain MRI revealed no metastasis from the primary skin lesion. This case highlights a rare combination of cell types found within a collision tumor in addition to providing details on how to diagnose this skin lesion.

Contributors to post-operative venous thromboembolism risk after breast cancer surgery: A systematic review and meta-analysis.

INTRODUCTION: Venous thromboembolism (VTE) events are a preventable complication for patients undergoing surgery for breast cancer. However, there is a lack of consistency in the existing literature regarding the potential risk factors affecting these individuals. METHODS: This study aimed to investigate the potential risk factors associated with an increased risk of VTE following surgery for breast cancer. Data on patient characteristics such as age, body mass index (BMI), existing comorbidities, smoking history, surgical interventions, duration of hospitalization, and post-operative complications were recorded and analyzed. RESULTS: Thirty-one studies investigating the incidence of VTE following surgical interventions for breast cancer were included. This study included 22,155 female patients with a mean age of 50.8 ± 2.9 years. The weighted mean length of surgery and hospital stay were 382.1 ± 170.0 min and 4.5 ± 2.7 days, respectively. The patients were followed-up for a weighted mean duration of 13.8 ± 21.2 months. The total incidence of VTE events was 2.2% (n = 489). Meta-analysis showed that patients with post-operative VTE had a significantly higher mean age and BMI, as well as longer mean length of surgery (P < 0.05). Comparing the techniques of autologous breast reconstruction showed that the risk of post-operative VTE is significantly higher with deep inferior epigastric perforator (DIEP) flaps, compared with the transverse rectus abdominus myocutaneous and latissimus dorsi myocutaneous flaps (P < 0.05). Compared with delayed reconstruction, immediate reconstruction was associated with a significantly higher incidence of VTE (P < 0.05). Smoking history, length of hospital stay, and Caprini score did not correlate with increased incidence of post-operative VTE. CONCLUSION: The incidence rate of VTE events in patients receiving surgical treatment for breast cancer is 2.2%. Risk factors for developing post-operative VTE in this patient population were found to be older age, increased BMI, extended length of surgical procedures, and DIEP flap reconstruction.

The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review.

This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss (n = 323, 62%), followed by motor deficits (n = 294, 56%) and neuropathic pain (n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage (n = 108, 6%), followed by neurolysis alone (n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.

Vitamins and Minerals for Blood Pressure Reduction in the General, Normotensive Population: A Systematic Review and Meta-Analysis of Six Supplements.

Hypertension is the leading preventable risk factor for cardiovascular disease and all-cause mortality worldwide. However, studies have shown increased risk of mortality from heart disease and stroke even within the normal blood pressure (BP) range, starting at BPs above 110-115/70-75 mm Hg. Nutraceuticals, such as vitamins and minerals, have been studied extensively for their efficacy in lowering BP and may be of benefit to the general, normotensive population in achieving optimal BP. Our study investigated the effects of six nutraceuticals (Vitamins: C, D, E; Minerals: Calcium, Magnesium, Potassium) on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in this population. We performed a systematic review and pairwise meta-analysis for all six supplements versus placebo. Calcium and magnesium achieved significant reductions in both SBP and DBP of -1.37/-1.63 mm Hg and -2.79/-1.56 mm Hg, respectively. Vitamin E and potassium only yielded significant reductions in SBP with values of -1.76 mm Hg and -2.10 mm Hg, respectively. Vitamins C and D were not found to significantly lower either SBP or DBP. Future studies should determine optimal dosage and treatment length for these supplements in the general, normotensive population.