The Readability and Quality of Web-Based Patient Information on Nasopharyngeal Carcinoma: Quantitative Content Analysis.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare disease that is strongly associated with exposure to the Epstein-Barr virus and is characterized by the formation of malignant cells in nasopharynx tissues. Early diagnosis of NPC is often difficult owing to the location of initial tumor sites and the nonspecificity of initial symptoms, resulting in a higher frequency of advanced-stage diagnoses and a poorer prognosis. Access to high-quality, readable information could improve the early detection of the disease and provide support to patients during disease management. OBJECTIVE: This study aims to assess the quality and readability of publicly available web-based information in the English language about NPC, using the most popular search engines. METHODS: Key terms relevant to NPC were searched across 3 of the most popular internet search engines: Google, Yahoo, and Bing. The top 25 results from each search engine were included in the analysis. Websites that contained text written in languages other than English, required paywall access, targeted medical professionals, or included nontext content were excluded. Readability for each website was assessed using the Flesch Reading Ease score and the Flesch-Kincaid grade level. Website quality was assessed using the Journal of the American Medical Association (JAMA) and DISCERN tools as well as the presence of a Health on the Net Foundation seal. RESULTS: Overall, 57 suitable websites were included in this study; 26% (15/57) of the websites were academic. The mean JAMA and DISCERN scores of all websites were 2.80 (IQR 3) and 57.60 (IQR 19), respectively, with a median of 3 (IQR 2-4) and 61 (IQR 49-68), respectively. Health care industry websites (n=3) had the highest mean JAMA score of 4 (SD 0). Academic websites (15/57, 26%) had the highest mean DISCERN score of 77.5. The Health on the Net Foundation seal was present on only 1 website, which also achieved a JAMA score of 3 and a DISCERN score of 50. Significant differences were observed between the JAMA score of hospital websites and the scores of industry websites (P=.04), news service websites (P<.048), charity and nongovernmental organization websites (P=.03). Despite being a vital source for patients, general practitioner websites were found to have significantly lower JAMA scores compared with charity websites (P=.05). The overall mean readability scores reflected an average reading age of 14.3 (SD 1.1) years. CONCLUSIONS: The results of this study suggest an inconsistent and suboptimal quality of information related to NPC on the internet. On average, websites presented readability challenges, as written information about NPC was above the recommended reading level of sixth grade. As such, web-based information requires improvement in both quality and accessibility, and healthcare providers should be selective about information recommended to patients, ensuring they are reliable and readable.

Three-Dimensional Volume Rendering of Pelvic Floor Anatomy with Focus on Fibroids in Relation to the Lower Urogenital Tract Based on Cross-Sectional MRI Images.

We aimed to assess the feasibility of developing three-dimensional (3D) models of pelvic organs using cross-sectional MRI images of patients with uterine fibroids and urinary symptoms and of obtaining anatomical information unavailable in 2D imaging modalities. We also aimed to compare two image processing applications. We performed a feasibility study analysing MRI scans from three women, aged 30 to 58 years old, with fibroids and urinary symptoms. Cross-sectional images were used to render 3D models of pelvic anatomy, including bladder, uterus and fibroids, using 3D Slicer and OsiriX. Dimensions, volumes and anatomical relationships of the pelvic organs were evaluated. Comparisons between anatomical landmarks and measurements obtained from the two image processing applications were undertaken. Rendered 3D pelvic models yielded detailed anatomical information and data on spatial relationships that were unobtainable from cross-sectional images. Models were rendered in sufficient resolution to aid understanding of spatial relationships between urinary bladder, uterus and fibroid(s). Measurements of fibroid volumes ranged from 5,336 to 418,012 mm3 and distances between the fibroid and urinary bladder ranged from 0.10 to 83.60 mm. Statistical analysis of measurements showed no significant differences in measurements between the two image processing applications. To date, limited data exist on the use of 3D volume reconstructions of routine MRI scans, to investigate pelvic pathologies such as fibroids in women with urinary symptoms. This study suggests that post-MRI image processing can provide additional information over standard MRI. Further studies are required to assess the role of these data in clinical practice, surgical planning and training. Three-dimensional reconstruction of routine two-dimensional magnetic resonance imaging provides additional anatomical information and may improve our understanding of anatomical relationships, their role in clinical presentations and possibly guide clinical and surgical management.

Analysis of top-cited articles on melanoma.

INTRODUCTION: This bibliometric analysis evaluates the most influential studies in clinical research on melanoma. METHODS: Based on the bibliometric theory, articles in the Thomson Reuters Web of Science database were analyzed. Full English-language articles were searched for using the terms melanoma, superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. The 100 most-cited articles were analyzed by topic, author, journal of publication, year of publication, institution, and country of origin. RESULTS: The search returned 243,109 articles, with the majority from the past 3 decades: 1991-2000 (n = 29), 2001-2010 (n = 28), and 2011-2020 (n = 30). The top 100 cited articles had mean and median citations of 2,159 and 1,793, respectively. An article on the use of ipilimumab in metastatic melanoma, by Hodi et al., was most cited (8,150). The New England Journal of Medicine had the most citations (58,489), and Nature published the most articles (n = 21). The United States published the most articles (n = 81), led by the National Cancer Institute (n = 16). The majority of articles explored management (n = 68), prognosis (n = 57), and immunotherapy (n = 27). CONCLUSIONS: This analysis serves as a guide for future research and highlights key areas of research, particularly in genetics and immunotherapy, that have influenced current knowledge of melanoma.

Early Exposure and Its Impact on Cardiothoracic Surgery: an Experience of Medical Education in The United Kingdom

ABSTRACT Introduction: Cardiothoracic surgery (CTS) has seen a decline in interest and application rates in recent years. As a relatively small speciality, teaching and placements in CTS are often not included during undergraduate study and postgraduate training. We aim to evaluate the exposure to CTS during both undergraduate study and postgraduate training. Methods: A ten-question online survey was designed and delivered to Foundation Year Two (FY2) doctors who graduated in 2017 and completed their two-year postgraduate foundation training in 2019. Medical schools with no graduates in 2017 and 2018 were excluded from our study. IBM® SPSS Statistics, version 25, and Microsoft Excel 365® were used for Student's t-test statistical analysis. Results: Three hundred and six FY2 doctors across 16 medical schools completed the survey, none of which included compulsory CTS attachments as their undergraduate curriculum. Thirty-two respondents (10.5%) underwent CTS attachments lasting between one to three weeks. Only 14 (43.8%) had worked in a cardiothoracic unit during their two-year Foundation Programme; 10 of which (71.2%) subsequently made an application for cardiothoracic speciality training. Most of the participants with previous exposure to CTS, during either undergraduate study or postgraduate Foundation Programme training or both, were significantly more likely to make an application to CTS training (P<0.05). Conclusion: Our study suggests that doctors with increased exposure to CTS during undergraduate study and postgraduate training are more likely to pursue a career in CTS. Targeted interventions at both stages may improve interests in CTS and the number of prospective applicants.

Understanding aortic valve repair through Ozaki procedure: A review of literature evidence.

BACKGROUND: Aortic valve neocuspidization (AV Neo) using glutaraldehyde-treated autologous pericardium was first reported by Ozaki et al. in 2007. This technique has become an alternative to tissue and mechanical valve in selected patients as long-term anticoagulation is not required and shows promising midterm results and durability. METHOD: A comprehensive search was performed on the major database using the search terms "Ozaki technique" AND "Aortic Valve Neocuspidization" AND "AV Neocuspidization" AND "Autologous pericardium" AND "glutaraldehyde-treated autologous pericardium." Articles up to August 1st, 2021 were included in this study. RESULTS: A total of nine studies with a total of 1342 patients were included. The mean age was 67.36 and 54.23% were male. 66.32% and 23.92% of patients had aortic stenosis and aortic regurgitation, respectively. 66% of patients had a native tricuspid aortic valve (AV) and 31.37% of patients' native AV was bicuspid. Three studies reported their experience performing AV Neo via ministernotomy. CONCLUSION: AV Neo can be a suitable alternative to surgical AV replacement in selected patients. The short- and midterm outcomes are comparable without the need for long-term oral anticoagulation. Long-term follow-up data are required for this novel approach to be widely adopted.

A quality assessment of online patient information regarding tonsillitis using the EQIP tool.

BACKGROUND: Tonsillitis is a common paediatric condition. The decision to seek medical attention and consent to treatment is usually made by parents or guardians. With increased accessibility of the internet, online medical information plays an increasingly significant role in the decision-making process. Little is known regarding the quality of online patient information on tonsillitis, as this has not been previously studied. OBJECTIVE: The aim of our study was to identify the quality of information regarding tonsillitis on websites intended for the public. METHODS: We conducted a systematic review of online information on tonsillitis using the following search terms: "Tonsillectomy", "Tonsillitis", "Adenotonsillectomy" and "Tonsil". The first three pages of returned websites were captured and each website was examined using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36). RESULTS: A total of 92 websites met the inclusion criteria for analysis. The overall median EQIP score was 19 with an interquartile range of 17-22 and a maximum of 32. More than half of all websites originated from the USA (61%) and hospitals were the most common source of information (29%). Most websites failed to describe the quantitative benefits or address the medical intervention costs and insurance issues. Half of the websites included both tonsillectomy and antibiotics as treatments for tonsillitis. Only 68% included complications of tonsillitis or tonsillectomy. CONCLUSIONS: The assessment of the quality of online patient information websites regarding tonsillitis by the EQIP tool indicates that most websites were of poor credibility, with minimal information regarding treatment choices and complications. To improve awareness of tonsillitis, there is a need for more informative and patient-centred websites that are compatible with the international quality standard for patient information.

Does multimodal perioperative pain management enhance immediate and short-term outcomes after living donor partial hepatectomy? A systematic review of the literature and expert panel recommendations.

BACKGROUND: The optimal analgesic strategy for patients undergoing donor hepatectomy is not known and the potential short- and long-term physical and psychological consequences of complications are significant. OBJECTIVES: To identify whether a multimodal approach to pain of the donor intraoperatively enhances immediate and short-term outcomes after living liver donation, and to provide international expert panel recommendations. DATA SOURCES: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. METHODS: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. PROSPERO 2021 CRD42021260699. RESULTS: Nine studies assessing multi-modal analgesia strategies were included in a qualitative assessment. Interventions included local, regional, and neuro-axial anesthetic techniques, pharmacological intervention (NSAIDs, COX-2 inhibitors, ketamine, dexmedetomidine, and lidocaine), and acupuncture. Overall, there was a significant (40%) reduction in opioid requirement on day 1 and a significant reduction in pain scores in the intervention vs control groups. Significant reductions in either length of stay or post-operative complications were demonstrated in four of nine studies. CONCLUSIONS: Opioid use for patients undergoing donor hepatectomy is likely to impact both their short- and long-term outcomes. To reduce post-operative pain scores, shorten length of hospital stay, and promote earlier post-operative return of bowel function, we recommend that multi-modal analgesia be offered to patients undergoing living donor hepatectomy. Further research is required to confirm which multi-modal techniques are most associated with enhanced recovery in living liver donors.

The Quality of Online Information on Cosmetic Injectable Fillers: Current Status.

Web-based health information plays an increasingly vital role in spreading health information. Many patients interested in aesthetic surgery study the procedure on the Internet. This study aims to evaluate the quality of online health information on injectable fillers using the modified "Ensuring Quality Information for Patients" (EQIP) tool. Nine different search terms, including "fillers," "fuller cheeks," "wrinkle removal," and "antiwrinkle treatment" were identified and queried on Google. Unique links from the first three pages of each search term were identified and evaluated if the contents were in English language and were for general non-medical public use. A total of 172 websites were analyzed, with a median EQIP score of 20. In total 129 websites belonged to aesthetic practitioners, of which 81 were operated by medical doctors. Eighty-three percent of websites disclosed some forms of postoperative complications, most commonly edema (74%) and bruising (73%). Blindness and tissue necrosis were only mentioned by 12 and 10% of the websites, respectively. The current health information available on injectable fillers is of poor quality. While many do provide some information on risks, the majority of websites fail to disclose severe complications and quantifying risks. This poses a barrier against informed decision-making and may lead to unrealistic expectations. Patient satisfaction and expectations may be improved by developing better online education resources on fillers.

Top 100 cited articles in male breast cancer: A bibliometric analysis.

BACKGROUND: Male breast cancer is a considerably rare condition and only accounts for 1% of all breast cancer cases. Due to limited public awareness, the condition is likely to present late, leading to late diagnosis and treatment worsening morbidity and mortality. This article aims to identify the focus and most influential research on male breast cancer. Objective Identify the most influential papers in male breast cancer. METHODS: Search on Web of Science using the search terms 'Male', 'Breast Cancer' and "Male breast cancer" to identify all full manuscripts in English language and were ranked by the total number of citations. The top 100 articles were then further analysed according to subject, author, journal, year and country of publications. RESULTS: The mean number of citations per paper was 96. Most cited paper was by Thorlacius, S et al. evaluating the relationship between BRCA2 and female breast cancer, prostate cancer, pancreatic cancer and ovarian cancer. Cancer is the journal with the most published papers and received most citations in the male breast cancer research field. The USA contributed 49 of the manuscripts in the top 100. The most studied topic was risk factors for male breast cancer, with 20 articles. CONCLUSIONS: The most cited papers identified in this study described the advance in the knowledge of genetics and epidemiology in male breast cancer and has led to improvements in the 4 management of the disease. Most of the highly cited articles in this field were published in high impact journals and had accumulated at least 100 citations to date, reflecting their quality and impact. By collating the most influential publications in this field, this analysis can serve to identify knowledge gaps in male breast cancer research as well as to help identify what makes a paper impactful and citable.

A Quality Assessment of Online Patient Information Regarding Rhinoplasty.

There is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the "Ensuring Quality Information for Patients" (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations.

Early Exposure and Its Impact on Cardiothoracic Surgery: an Experience of Medical Education in The United Kingdom.

INTRODUCTION: Cardiothoracic surgery (CTS) has seen a decline in interest and application rates in recent years. As a relatively small speciality, teaching and placements in CTS are often not included during undergraduate study and postgraduate training. We aim to evaluate the exposure to CTS during both undergraduate study and postgraduate training. METHODS: A ten-question online survey was designed and delivered to Foundation Year Two (FY2) doctors who graduated in 2017 and completed their two-year postgraduate foundation training in 2019. Medical schools with no graduates in 2017 and 2018 were excluded from our study. IBM® SPSS Statistics, version 25, and Microsoft Excel 365® were used for Student's t-test statistical analysis. RESULTS: Three hundred and six FY2 doctors across 16 medical schools completed the survey, none of which included compulsory CTS attachments as their undergraduate curriculum. Thirty-two respondents (10.5%) underwent CTS attachments lasting between one to three weeks. Only 14 (43.8%) had worked in a cardiothoracic unit during their two-year Foundation Programme; 10 of which (71.2%) subsequently made an application for cardiothoracic speciality training. Most of the participants with previous exposure to CTS, during either undergraduate study or postgraduate Foundation Programme training or both, were significantly more likely to make an application to CTS training (P<0.05). CONCLUSION: Our study suggests that doctors with increased exposure to CTS during undergraduate study and postgraduate training are more likely to pursue a career in CTS. Targeted interventions at both stages may improve interests in CTS and the number of prospective applicants.

Top 100 Most Influential Manuscripts in Congenital Abdominal Pediatric Surgery: A Bibliometric Analysis.

Bibliometric analysis identifies the most influential manuscripts that shape our understanding of various congenital gastrointestinal pathologies. This study sets out to analyse the 100 most cited manuscripts on congenital gastrointestinal surgery. The Thomson Reuters Web of Science database was searched for all manuscripts relevant to paediatric congenital gastrointestinal surgery. The number of citations, authorship, publication date, journal of publication, institution and country were recorded for each paper. Eigenfactor and impact factor rankings were obtained for each journal of publication. 971 eligible manuscripts were returned by the search. Within the top 100 manuscripts, the most cited paper (by Metkus et al.) investigated fetal diaphragmatic hernia and was cited 413 times. University of Indianapolis had the most publications (n=5) and Journal of Pediatric Surgery had the most citations (n=3231). The country with the most publications in top 100 were the USA (n=39). The most commonly published topics were diaphragmatic hernia (n=23), abdominal wall defect (n=20) and atresia (n=6). The most cited manuscripts include various topics with a primary focus on the aetiology, diagnosis, management and outcome of diaphragmatic hernia and abdominal wall defects. Additionally, by collecting the most influential works, this study serves to reference what makes a manuscript 'citable'.

Using the Ensuring Quality Information for Patients Tool to Assess Patient Information on Appendicitis Websites: Systematic Search and Evaluation.

BACKGROUND: Appendicitis is a common surgical problem among the young adult population, who are likely to use the internet to obtain medical information. This information may determine the health-seeking behavior of an individual and may delay medical attention. Little is known regarding the quality of patient information on appendicitis on the internet, as this has not been previously studied. OBJECTIVE: The aim of our study was to identify the quality of information regarding appendicitis on websites intended for the public. METHODS: We conducted a systematic review of information on appendicitis available online using the following 4 search terms in google: "appendicitis," "appendix," "appendectomy," and "appendicectomy". The top 100 websites of each search term were assessed using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36). RESULTS: A total of 119 websites met the eligibility criteria for evaluation. The overall median EQIP score for all websites was 20 (IQR 18-22). More than half the websites originated from the USA (65/119, 54.6%), and 45.4% (54/119) of all websites originated from hospitals, although 43% (23/54) of these did not mention qualitative risks from surgery. Incidence rates were only provided for complications and mortality in 12.6% (15/119) and 3.3% (4/119) of all websites, respectively. CONCLUSIONS: The assessment of the quality and readability of websites concerning appendicitis by the EQIP tool indicates that most sites online were of poor credibility, with minimal information regarding complication rates and mortality. To improve education and awareness of appendicitis, there is an immediate need for more informative and patient-centered websites that are more compatible with international quality standards.

Gene therapy in wound healing using nanotechnology.

Wound healing is a complex and highly regulated process that is susceptible to a variety of failures leading to delayed wound healing or chronic wounds. This is becoming an increasingly global burden on the healthcare system. Treatment of wounds has evolved considerably to overcome barriers to wound healing especially within the field of regenerative medicine that focuses on the replacement of tissues or organs. Improved understanding of the pathophysiology of wound healing has enabled current advances in technology to allow better optimization of microenvironment within wounds. This approach may help tackle wounds that are difficult to treat and help reduce the global burden of the disease. This article provides an overview of the physiology in wound healing and the application of gene therapy using nanotechnology in the management of wounds.

COVID-19 prevention and treatment information on the internet: a systematic analysis and quality assessment.

OBJECTIVE: To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries. DESIGN: Systematic analysis using the 'Ensuring Quality Information for Patients' (EQIP) Tool (score 0-36), Journal of American Medical Association (JAMA) benchmark (score 0-4) and the DISCERN Tool (score 16-80) to analyse websites containing information targeted at the general public. DATA SOURCES: Twelve popular search terms, including 'Coronavirus', 'COVID-19 19', 'Wuhan virus', 'How to treat coronavirus' and 'COVID-19 19 Prevention' were identified by 'Google AdWords' and 'Google Trends'. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information. RESULTS: Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001). CONCLUSION: This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.

The Evolution of Mitral Valve Surgery: the Future in the Hand of Robots.

OBJECTIVE: To examine the current literature behind the evolution of mitral valve surgery techniques and their impact on patient outcomes. METHODS: An electronic literature search among major databases was performed (PubMed, Embase, Scopus, Cochrane, and Google scholar). All the relevant articles were screened and identified to be included in this narrative review. The main outcomes were postoperative morbidity, length of in-hospital stay, and long-term mortality. RESULTS: Minimally invasive and robot-assisted approach to mitral valve repair and replacements has shown great potential in improving surgical outcomes when compared against traditional midline sternotomy. Selected patients can benefit from percutaneous mitral valve surgery; however, more evidence is required to ascertain its long-term outcomes. CONCLUSION: Current evidence suggests that robotic and minimal invasive mitral valve surgeries are increasing in practice with satisfactory perioperative and mortality rates. However, long-term data is yet to be published to support current practice.

Techniques and approaches for revascularisation of left heart coronary diseases.

Coronary artery disease and its associated clinical sequelae are a significant medical burden to clinicians and patients. Severe coronary artery disease presenting in the context of acute myocardial ischaemia, or stable plaques causing chronic symptoms despite best conservative and pharmacological intervention, are often amenable to further intervention such as coronary artery bypass grafting. This procedure has been extensively compared to newer and less invasive techniques, such as percutaneous coronary intervention, and other minimally invasive procedures such as robotic or endoscopic techniques. This review summarises the current evidence on revascularisation of the left coronary artery system, with particular emphasis on key clinical endpoints of mortality, myocardial infarction, stroke and repeat revascularisation.

Top 100 cited manuscripts in aortic valve replacement: A bibliometric analysis.

This bibliometric analysis aims to identify publications and highlight the key areas that have shaped modern clinical practices for aortic valve replacement (AVR). In this paper, the top 100 most cited manuscripts for AVR are analyzed. The Thomson Reuters Web of Science database was searched using the terms "aortic valve replacement," "AVR," "sAVR," "tAVR," or "TAVI." The results were ranked by citation number and the top 100 articles were further analyzed by evaluating the subject, author, journal, year of publication, institution, and country of origin. Thirty-thousand and eight hundred eligible papers were examined, with an accumulation of 81 851 citations in total and a mean citation of 819 per manuscript (ranged: 344-4180). The New England Journal of Medicine had the most manuscripts whereas Circulation had the most citations. The number of citations has also significantly increased for articles published after 2000.The most cited manuscript highlighting the management of valvular heart disease, was written by Baumgartner et al By providing the most influential references, this work serves as a comprehensive guide to topics of interest in the field of AVR.