Readability and quality assessment of online patient education materials for spinal and epidural anesthesia.

PURPOSE: Guidelines recommend that health-related information for patients should be written at or below the sixth-grade level. We sought to evaluate the readability level and quality of online patient education materials regarding epidural and spinal anesthesia. METHODS: We evaluated webpages with content written specifically regarding either spinal or epidural anesthesia, identified using 11 relevant search terms, with seven commonly used readability formulas: Flesh-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease (FRE), and New Dale-Chall (NDC). Two evaluators assessed the quality of the reading materials using the Brief DISCERN tool. RESULTS: We analyzed 261 webpages. The mean (standard deviation) readability scores were: FKGL = 8.8 (1.9), GFI = 11.2 (2.2), CLI = 10.3 (1.9), ARI = 8.1 (2.2), SMOG = 11.6 (1.6), FRE = 55.7 (10.8), and NDC = 5.4 (1.0). The mean grade level was higher than the recommended sixth-grade level when calculated with six of the seven readability formulas. The average Brief DISCERN score was 16.0. CONCLUSION: Readability levels of online patient education materials pertaining to epidural and spinal anesthesia are higher than recommended. When we evaluated the quality of the information using a validated tool, the materials were found to be just below the threshold of what is considered good quality. Authors of educational materials should provide not only readable but also good-quality information to enhance patient understanding.

RéSUMé: OBJECTIF: Les lignes directrices recommandent que les informations relatives à la santé destinées aux patient·es soient rédigées pour un niveau de sixième année ou en dessous. Nous avons cherché à évaluer le niveau de lisibilité et la qualité des matériels d'éducation disponibles en ligne pour les patient·es concernant l'anesthésie péridurale et la rachianesthésie. MéTHODE: Nous avons évalué les pages web dont le contenu était spécifiquement rédigé à propos de l'anesthésie rachidienne ou péridurale, identifiées à l'aide de 11 termes de recherche pertinents, avec sept formules de lisibilité couramment utilisées : Niveau scolaire Flesh-Kincaid (FKGL), Indice Gunning Fox (GFI), Indice Coleman-Liau (CLI), Indice de lisibilité automatisé (ARI), Mesure simple du charabia (SMOG), Facilité de lecture de Flesch (FRE) et New Dale-Chall (NDC). Deux personnes ont évalué la qualité du matériel de lecture à l'aide de l'outil Brief DISCERN. RéSULTATS: Nous avons analysé 261 pages web. Les scores de lisibilité moyens (écart type) étaient les suivants : FKGL = 8,8 (1,9), GFI = 11,2 (2,2), CLI = 10,3 (1,9), ARI = 8,1 (2,2), SMOG = 11,6 (1,6), FRE = 55,7 (10,8) et NDC = 5,4 (1,0). Le niveau de lecture moyen était plus élevé que le niveau recommandé de sixième année lorsqu'il a été calculé à l'aide de six des sept formules de lisibilité. Le score moyen de Brief DISCERN était de 16,0. CONCLUSION: Les niveaux de lisibilité des documents d'éducation en ligne relatifs à l'anesthésie péridurale et à la rachianesthésie destinés aux patient·es sont plus élevés que ceux recommandés. Lorsque nous avons évalué la qualité de l'information à l'aide d'un outil validé, nous avons constaté que les documents se situaient juste en dessous du seuil de ce qui est considéré comme de bonne qualité. Les personnes rédigeant du matériel éducatif doivent fournir des informations non seulement lisibles, mais aussi de bonne qualité afin d'améliorer la compréhension des patient·es.

A contemporary systematic review of the complications associated with SURGICEL.

BACKGROUND: This review aims to summarize the findings from recent literature (2010-2022) reporting on complications that resulted from the surgical use of SURGICEL for intraoperative hemostasis. METHODS: A literature search was conducted using the MEDLINE (OVID), Embase, and Cochrane Central Register of Controlled Trials - CENTRAL (OVID) databases. The studies were sorted into case reports and other study types for data extraction. Covidence was used for data extraction and statistics were descriptive. RESULTS: Of the total 560 articles screened, 73 papers were selected for a full-text review and 70 studies were included in this review. A total of 7,242 participants were included in the studies (case studies n = 93, others n = 7149). 67/70 of the included studies reported complications when SURGICEL was used intraoperatively. Reported complications included: SURGICEL induced masses (granulomas, abscesses, hematomas, cysts) (n = 25), hemorrhagic complications (n = 12), masses misdiagnosed as tumors, cardiovascular, nervous system, and hepatobiliary complications, pain, and infections. Other complications included: fistulas, erectile dysfunction, chorioamnionitis, swelling, urinary leak, renal failure, and anaphylaxis. CONCLUSIONS: Publications reporting on complications associated with the use of SURGICEL intraoperatively have continued to emerge. Future studies should compare how the types and rates of complications compare between SURGICEL and alternative hemostatic agents.

Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis.

OBJECTIVE: We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment. BACKGROUND: Normohormonal primary hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients. METHODS: A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated. RESULTS: Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003). CONCLUSION: Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE.

A Multi-Disciplinary Approach to Perianal Fistulizing Crohn's Disease.

Perianal fistulizing Crohn's disease represents a severe phenotype associated with significant morbidity. Patients with perianal fistulizing disease are more likely to have a severe disease course and have significant reductions in quality of life. Moreover, these patients are at risk for the development of distal rectal and anal cancers. Given the complexity and severity of this patient group, the management of perianal Crohn's disease must be undertaken by a multidisciplinary team. The gastroenterologist and colorectal surgeon play a critical role in the diagnosis and management of perianal fistulizing disease. An examination under anesthesia provides critical information and is an essential part of the work-up of complex perianal fistulas. The radiologist also plays a central role in characterizing anatomy and assessing response to treatment. Several imaging modalities are available for these patients with magnetic resonance imaging as the imaging modality of choice. Perianal disease developing after ileal pouch-anal anastomosis represents a particularly challenging form of fistulizing disease and requires a multidisciplinary clinical and radiologic approach to differentiate surgical complications from recurrent Crohn's disease.

Current surgical treatment of intermediate risk differentiated thyroid cancer: a systematic review.

Introduction: Surgical treatment of thyroid cancer has become less aggressive but for many patients, the threshold for performing total thyroidectomy (TT), as opposed to thyroid lobectomy (TL), has remained unclear. Current American Thyroid Association (ATA) guidelines encourage more individualization of treatment options, which necessitates explicit review of the pros and cons of the different options with patients.Areas covered: This review focuses on the extent of surgery for treatment of intermediate-risk differentiated thyroid cancer, restricted to relevant literature available after publication of the 2015 ATA guidelines.Expert opinion: Dynamic risk-stratification facilitates a tailored approach when deciding on the extent of surgery for thyroid cancer. Treatment with TT allows for a lower recurrence risk, a simpler follow-up regimen, and treatment with adjuvant post-operative radioactive iodine. Treatment with TL has a lower associated risk of complications and avoidance of lifelong thyroid hormone replacement but has a significant risk of requiring a completion thyroid lobectomy (CT). Overall, treatment with TL and TT have comparable survival outcomes, but TL is the more cost-effective option. Larger cancer size is correlated with worse clinical outcomes, and numerous subgroup analyses have shown poorer outcomes for cancers with a diameter that is 2-4 cm compared to 1-2 cm.