Propofol-Related Infusion Syndrome in a Child With Refractory Status Epilepticus: Successful Resuscitation With Veno-Arterial Extracorporeal Membrane Oxygenation, Continuous Renal Replacement Therapy, and Therapeutic Plasma Exchange.

Propofol is used for sedation, anxiolysis, anesthesia induction, and as an anticonvulsant. In cases of refractory status epilepticus (RSE), propofol is more efficient than barbiturates. We present a case of a 3-year-old female with RSE who developed propofol-related infusion syndrome (PRIS) despite low dosage after failed attempts with multiple anti-epileptic drips and bolus therapies. Careful consideration must be made before initiating propofol administration for RSE. We discuss our PRIS treatment approach with extracorporeal membrane oxygenation, therapeutic plasma exchange, and continuous renal replacement therapy leading to our patient recovering to baseline and being discharged home from the hospital.

Successful Administration of Preoperative Botox for Giant Omphalocele Repair With Ultrasound Guidance.

We present a case of a four-year-old male with a history of giant omphalocele who underwent ultrasound-guided Botox injection to bilateral anterior abdominal wall musculature in preparation for definitive repair. Botox administration was successfully combined with preoperative subfascial tissue expanders to achieve definitive midline closure of the anterior abdominal wall defect. Our experience suggests that Botox can be safely used as part of the treatment plan for giant omphalocele repair.

Analyzing opioid-use disorder websites in the United States: An optimized website usability study.

Background: As the United States continues to tackle the opioid epidemic, it is imperative for digital healthcare organizations to provide Internet users with accurate and accessible online resources so that they can make informed decisions with regards to their health. Objective: The primary objectives were to adapt and modify a previously established usability methodology from literature, apply this modified methodology in order to perform usability analysis of opioid-use-disorder (OUD)-related websites, and make important recommendations that OUD-related digital health organizations may utilize to improve their online presence. Methods: A list of 208 websites (later refined) was generated for usability testing using a modified Google Search methodology. Four keywords were chosen and used in the search: "DEA-X Waiver Training", "opioid-use-disorder (OUD) Initiatives", "Buprenorphine Assisted Treatment", and "Opioid-Use Disorder Websites". Usability analysis was performed concurrently with optimization of the methodology. OUD websites were analyzed and scored on several usability categories established by previous literature. Results: "DEA-X Waiver Training" yielded websites that scored the highest average in "Accessibility" (0.84), while "Opioid-Use Disorder Websites" yielded websites that scored the highest average in "Content Quality" (0.67). "Buprenorphine Assisted Treatment" yielded websites that scored the highest average across "Marketing" (0.52), "Technology" (0.89), "General Usability" (0.69), and "Overall Usability" (0.68). "Technology" and "Marketing" were the highest and lowest scoring usability categories, respectively. T-test analysis revealed that each usability, except "Marketing" had a pair of one or more keywords that were significantly different with a p-value that was equal to or less than 0.05. Conclusions: Based on the study findings, we recommend that digital organizations in the OUD space should improve their "General Usability" score by making their websites easier to find online. Doing so, may allow users, especially individuals in the OUD space, to discover accurate information that they are seeking. Based on the study findings, we also made important recommendations that OUD-related digital organizations may utilize in order to improve website usability as well as overall reach.

Website Usability Analysis of U.S. Military Residency Programs.

INTRODUCTION: The Military Match is the residency matching system for medical students attending the Uniformed Services University of Health Sciences, and the students were funded by the Health Professions Scholarship Program through the U.S. Army, Air Force, and Navy. To evaluate and compare military residency programs, students use residency program websites. Often, the residency program's website serves as a key source, or the only point of reference, when considering residency options, especially during times when face-to-face interactions are limited.This report aims to provide a systematic evaluation of military residency programs and their websites. MATERIALS AND METHODS: Utilizing a previously published website usability scoring system, military residency programs were categorized to objectively and quantitatively analyze their websites. Usability was divided into four categories for quantifiable analysis: accessibility, marketing, content quality, and technology. The methodology for this analysis was replicated from published reports that have examined healthcare website usability. Each website was analyzed and scored in four categories: accessibility, content quality, marketing, and technology. A "General Usability" score was calculated for each website using a composite of the key factors within the four categories. An overall score was generated utilizing the weighted percentage across all four categories. To address deficiencies of the original methodology, a secondary analysis was performed on the listed websites utilizing an automated methodology for website usability. RESULTS: A comprehensive list of 125 Accreditation Council for Graduate Medical Education U.S. Military residency program websites was compiled. Of these, 96 programs and 106 websites were evaluated. The primary analysis employing usability methodology identified technology as the highest ranked category with a score of 0.749 (SD ± 0.039) (SE 0.005) (P < .05). Marketing and content quality were the lowest scoring categories with mean scores of 0.414 (SD ± 0.054) (SE 0.006) and 0.428 (SD ± 0.229) (SE 0.027), respectively (P < .05). There was no significant difference in overall usability rankings or scores among the 96 residency program websites across the three branches (P < .05).Secondary analysis with the new usability methodology demonstrated military residency websites to exhibit more external backlinking compared to internal backlinking (P < 0.05) and no social media backlinking to any of the 106 analyzed websites. When comparing the three services, the Army had significantly lower external backlinking ranking 43.4 (P < .05) and overall backlinking ranking 56.4 (P < 0.05) when compared to the Navy (mean 48.8 and 71.7, and 43.4). There were no other differences in backlinking rankings across the three branches. CONCLUSIONS: Residency websites have become a primary way to communicate information to applicants. By assessing the overall usability of the various military residency websites, we determined the effectiveness of these websites to relay information to prospective students interested in applying for military residency. We predict that by improving website accessibility, residency programs increase their effectiveness at communicating information to potential applicants and increase interest in military residency programs.

American Anesthesiology Residency Programs: Website Usability Analysis.

BACKGROUND: The Association of American Medical Colleges has recently issued recommendations for the upcoming 2022-2023 application cycle that residency programs should conduct all interviews for this upcoming application cycle over the web. In light of these recommendations, many students will have limited exposure to anesthesiology programs and will rely on information gleaned digitally. This change means that the aspects of program websites used to provide information, such as size, structure, location, requirements, and contact information, will be crucial in helping prospective residents decide where and how to apply in the future. An evaluation of website usability, which includes initial appearance along with factors that influence its ease of navigation and convenience of use, can thus be applied to anesthesiology residency websites. Areas of need can be targeted to increase web presence and provide effective pathways to exhibit the different attributes of their programs to future applicants. OBJECTIVE: This study aimed to compile a list of US anesthesiology residency programs and their websites while objectively analyzing the websites using a formally published usability scoring system, as well as to identify positive and negative trends to offer areas of improvement among anesthesiology residency websites. METHODS: We included only 114 US anesthesiology residency program websites in our sample set, since some websites we analyzed showed errors or inconclusive. Website usability was separated into 4 distinct categories for analysis based on methodology outlined in previous literature on both health care website usability and residency website usability. The 4 categories were Accessibility, Marketing, Content Quality, and Technology. Each website was then analyzed and scored based on key components highlighted within the 4 categories. The multiple factors were then graded using a percentage system to create a comprehensive score for each program. RESULTS: The highest scoring category was Content Quality (mean 4.7, SD 2.48, SE 0.23). The lowest scoring category was Technology (mean 0.9, SD 0.38, SE 0.04). CONCLUSIONS: Through the application of a health care website usability framework, multiple anesthesiology residency programs were analyzed and scored in the areas of Accessibility, Marketing, Content Quality, and Technology, which allowed us to determine the effectiveness of the usability of these websites to convey information to their end user. Websites must communicate vital information, with usability at the forefront, to continue to grow, especially as the United States faces challenges due to the COVID-19 pandemic. Our recommendation is that anesthesiology programs should strive to improve website usability to increase the ease by which applicants can collect vital information about anesthesiology programs. A few proposed solutions include making changes such as decreasing error pages on websites, migrating away from using in-line cascading style sheets, and improving web page loading speeds to improve the Technology category.

Methodological Guidelines for Systematic Assessments of Health Care Websites Using Web Analytics: Tutorial.

With the growing importance of communicating with the public via the web, many industries have used web analytics to provide information that organizations can use to better achieve their goals. Although the importance of health care websites has also grown, the health care industry has been slower to adopt the use of web analytics. Web analytics are the measurement, collection, analysis, and reporting of internet data used to measure direct user interaction. Our objective is to provide generalized methods for using web analytics as key performance metrics to evaluate websites and outline actionable recommendations for improvement. By deconstructing web analytic categories such as engagement, users, acquisition, content, and platform, we describe how web analytics are used to evaluate websites and how improvements can be made using this information. Engagement is how a user interacts with a website. It can be evaluated using the daily active users to monthly active users (DAU/MAU) ratio, bounce rate, pages viewed, and time on site. Poor engagement indicates potential problems with website usability. Users pertains to demographic information regarding the users interacting with a website. This data can help administrators understand who is engaging with their website. Acquisition refers to the overall website traffic and the method of traffic, which allows administrators to see how people are accessing their website. This information helps websites expand their methods of attracting users. Content refers to the overall relevancy, accuracy, and trustworthiness of a website's content. If a website has poor content, it will likely experience difficulty with user engagement. Finally, platform refers to the technical aspects of how people access a website. It includes both the internet browsers and devices used. By providing detailed descriptions of these categories, we have identified how web administrators can use web analytics to systematically assess their websites. We have also provided generalized recommendations for actionable improvements. By introducing the potential of web analytics to augment usability and the conversion rate, we hope to assist health care organizations in better communicating with the public and therefore accomplishing the goals of their websites.

An Analysis of US Academic Medical Center Websites: Usability Study.

BACKGROUND: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. OBJECTIVE: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. METHODS: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital's website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall "general usability" score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final "overall usability" ranking. RESULTS: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. CONCLUSIONS: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user's experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability.

Website usability analysis of United States emergency medicine residencies.

OBJECTIVES: The Council of Residency Directors (CORD) in Emergency Medicine (EM) has recommended that all residency programs should conduct virtual interviews for the 2020 to 2021 application cycle due to the COVID-19 pandemic. While factors such as geographical region, city, program size, or hospital affiliation are not modifiable, EM residencies can bridge the information gap created by a lack of face-to-face interaction by representing themselves digitally. Measuring usability provides an objective method for EM residencies to improve their Web presence and effectively represent themselves to applicants. METHODS: Our sample set included 55 U.S. EM residency program websites. Using methodology replicated from previous literature on health care website usability, we divided usability into four categories for quantifiable analysis: accessibility, marketing, content quality, and technology. Analysis was performed on each website and scored in all four categories. A "general usability" score was calculated for each website using a composite of the key factors within the four categories. Using a weighted percentage across all of the factors, an overall score was calculated. RESULTS: Content quality was the overall highest scoring category (mean ± SD = 5.4, SE = 0.33). The overall lowest performing category was technology (mean ± SD = 0.8 ± 0.09, SE = 0.01). CONCLUSIONS: Measuring usability can help EM residency programs identify ways to improve their Web presence. To effectively promote their programs, residencies need quality content that communicates their key features. Our recommendation is for all residency programs to periodically perform website audits and apply the usability measures outlined to improve their digital presence, especially during times when face-to-face interactions will be limited.

Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study.

BACKGROUND: As the public increasingly uses the internet to search for resources and information regarding health and medicine, it is important that health care organizations provide adequate web resources. Website usability refers to the ease of user experience on a website. In this study, we conducted usability analyses on digital health center websites. OBJECTIVE: The primary aims of this study were to (1) replicate a preexisting usability scoring methodology for digital health centers; (2) apply and test this replicated usability scoring methodology on a sample set of digital health center websites; and (3) derive recommendations from the results on potential areas of improvements for our sample of digital health center websites. METHODS: Website usability testing was conducted from March 1, 2020, to March 15, 2020. We replicated a methodology and scoring system from previous literature and applied them to digital health center websites. Our sample included 67 digital health centers that were affiliated with US universities or hospital systems. Usability was split into the following four broad categories: accessibility, marketing, content quality, and technology. Usability tools were used to score websites in each of the four categories. The composite of the key factors of each category was used to generate a general usability and overall usability score for each website. RESULTS: The category with the highest average score (6.3) was content quality. The content quality score also had the highest SD (2.18) and an SE of 0.27. The lowest performing category was technology, which had an average score of 0.9. The technology score also had the smallest SD (0.07) and an SE of 0.01. CONCLUSIONS: Our data suggest that content quality, on average, was the highest scoring variable among digital health center websites. As content is crucial to digital health knowledge, it is justified that digital health centers invest more resources into creating quality content. The overall lowest scoring variable was technology. Potential reasons for this finding include designated funding for servers, a lack of regulatory frameworks for social media presence and liability, and infrequent website audits. An easy approach for improving this variable is increasing website speed. Accessibility is another area that organizations can potentially improve. We recommend that these organizations perform periodic audits of their web presence with usability tools.

Addressing immediate public coronavirus (COVID-19) concerns through social media: Utilizing Reddit's AMA as a framework for Public Engagement with Science.

COVID-19 has highlighted an opportunity for medical professionals to engage in online Public Engagement with Science (PES). Currently a popular platform for PES is Reddit. Reddit provides an Ask Me Anything (AMA) format for subject matter experts to answer questions asked by the public. On March 11, 2020, from 2:00 to 4:00pm EST, two Emergency Department physicians from Massachusetts General Hospital hosted an AMA session on coronavirus. We retroactively conducted an analysis of the questions and answers from this AMA session in order to better understand the public's concerns around coronavirus and identify future opportunities for medical experts to leverage the Reddit AMA format in communicating with the general public. Results suggested that participants sought not only to obtain information, but to engage in discussion, and did so with each other in the absence of expert responses. The majority of bi-directional discussion occurred between participants. Due to the volume of questions and ratio of experts to participants, not all questions were answered. More posts provided facts or opinions, than posts that providing resources or requesting resources.