Readability, reliability and credibility of online patient information on skin grafts.

BACKGROUND: Skin grafting reflects a common dermatological procedure for closing skin defects. Patient education is important for managing expectation and optimising skin graft take. While health information is increasingly accessed on the internet, there are no existing studies assessing their quality. METHODS: The first 25 results from Google, Microsoft Bing and Yahoo! search engines using the term 'skin graft' were analysed using a variety of standard instruments. Readability was assessed using the Flesch-Kincaid Grade score (FKG), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG) and the New Dale-Chall Readability Index (NDC). Reliability was assessed using the DISCERN instrument and credibility with the Journal of the American Medical Association Benchmark Criteria (JAMA). Transparency was identified by presence of the Health On the Net Foundation Code certification (HON-code). RESULTS: Seventy-five websites were identified. After exclusion, forty-three remaining websites were analysed with average FKG, GFI and SMOG scores of 7.8, 10.1 and 10.7, respectively. The average NDC was 5.9. The average reliability was fair with a DISCERN score based on the first 15 questions of the instrument of 42.6. The mean JAMA score was 2, and 9 websites displayed the HON-code certificate. CONCLUSIONS: Readability, reliability and credibility of online health information regarding skin grafting can be improved. Health care providers should critically assess existing online patient information or develop alternative material to educate patients undergoing skin graft surgery.

Management dilemma in metastatic papillary thyroid carcinoma.

Papillary thyroid cancer is the most common type of well-differentiated thyroid cancer. It is associated with a survival rate greater than 95% with appropriate treatment, particularly in younger patients. We present the unique case of a 25-year-old male with severe Autistic spectrum disorder (ASD) with a right level V neck mass of several months. Due to his severe ASD, his first assessment was conducted in the hospital foyer, and every subsequent clinical assessment and blood test required a general anaesthetic (GA). He was subsequently diagnosed with T2 N1b M0 (Stage I) papillary thyroid cancer. He required extensive multidisciplinary team (MDT) input to determine the goal for his treatment whilst taking into consideration perioperative care, wound management, compliance with exam and blood tests, radioactive iodine administration and lifelong medication requirements if total thyroidectomy was considered. Following multiple MDT and family meetings, the decision was made to proceed with right hemi-thyroidectomy, right level I-V and central neck dissection. He required one-week stay in the intensive care unit under sedation post-operatively, and was discharged from hospital a further six days later with no complications. He is currently being followed-up every six months which presents its own challenges. This case highlights the extraordinary challenges and considerations that need to be made when dealing with surgical pathology in a patient with severe intellectual disability, even in the setting of a relatively common surgical pathology.

Evaluation of readability and reliability of online patient information for intracranial aneurysms.

INTRODUCTION: Intracranial aneurysms are common. Receiving this diagnosis can have a profound impact on patients and their families and this is compounded by the nuanced complexities around their management. An overwhelming majority of patients research health information using the internet. Patient-centred care and informed consent requires patients to have access to information that is readable and reliable. The aim of this study was to assess the readability and reliability of online health information about intracranial aneurysms. METHOD: A Google search was conducted using the terms 'brain aneurysm', 'cerebral aneurysm', and 'intracranial aneurysm' and the first 75 websites were screened for assessment. The readability of each website was assessed using the Flesch reading ease score (FRE), the Flesch-Kincaid grade level (FKGL), the gunning fog index (GFI) and the simple measure of gobbledygook (SMOG) indices. Reliability was assessed using the DISCERN instrument and the Journal of the American Medical Association benchmark criteria (JAMA). RESULTS: Following exclusion, 36 websites were analyzed. The websites collectively scored as 'difficult' readability and 'poor' reliability on average. Statistically significant differences in readability were observed between websites categorized as patient health information and commercial compared with academic and physician. Differences in readability were also observed between search results of 'brain aneurysm' compared with 'intracranial aneurysm'. CONCLUSION: The readability and reliability of online health information about intracranial aneurysms is suboptimal. Health professionals must ensure their patients are well informed which includes directing them to high quality resources which are readable and reliable and use layperson-oriented language during the consultation.

Spontaneous atraumatic lingual haematoma presenting with threatened airway obstruction.

Spontaneous bleeding in the head and neck region is exceedingly rare, particularly in the absence of trauma or an underlying disorder. We describe a case of an atraumatic lingual haematoma in an 88-year-old male presenting with threatened airway obstruction. The only risk factor our patient had was Aspirin use. Our patient was able to be managed conservatively with observation in the hospital's high dependency unit (HDU) and intravenous steroid (Dexamethasone) and antibiotic (Amoxicillin + Clavulanic acid) therapy. We discuss this case to highlight the importance of recognising an impending airway emergency in the setting of deep space bleeding or swelling.