Evaluating the Quality and Readability of Online Resources on Unspecified Kidney Donation.

BACKGROUND: Unspecified kidney donation (UKD) refers to transplantation from donors unrelated and unknown to the recipient. UKD has contributed to the expansion of the live donor pool in several countries. The United Kingdom Transplant Community has set maximizing UKDs as a priority. The Internet raises awareness and potentially influences the decision-making regarding UKD. This is the first study assessing the quality and readability of online material on UKD. MATERIALS AND METHODS: Google was searched for the terms "kidney donation" and one of "unspecified," "altruistic," "non-directed," "anonymous," or "good Samaritan," as well as "giving or donating a kidney to a stranger." Two independent assessors reviewed the top 100 websites. Quality was assessed using the Journal of the American Medical Association criteria, the DISCERN instrument and Health On the Net Code certification. Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG), and Simple Measure of Gobbledygook (SMOG) scores. RESULTS: Only 6% of websites displayed HONcode certification. The mean (± SD) JAMA and DISCERN scores of 1.96 (± 1.00) and 32.34 (± 11.19) indicate poor quality. The mean (± SD) FRE, FKG, and SMOG scores of 52.92 (± 13.62), 10.60 (± 2.72), and 9.64 (± 2.22) reveal poor readability. The difference in JAMA and DISCERN scores according to website classification was significant (P < .001, P = .014) with websites from medical, nonprofit, and governmental organizations scoring amongst the lowest, while comprising most search results (61%). CONCLUSIONS: Transplant centers and medical organizations should prioritize improving their online resources to lower the risk of individuals pursuing UKD based on unrealistic expectations or being discouraged unjustly.

Promising Treatment Options for Axial Spondyloarthritis: An Overview of Experimental Pharmacological Agents.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition that predominantly affects the axial skeleton. All patients receive conservative management measures which include physiotherapy, patient education and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Those with significant active disease will require escalation of their treatment with the use of biologics. Currently, there are five approved TNF inhibitors and two approved IL-17 inhibitors for use in axSpA. However, despite this up to 40% of patients do not respond or are intolerant to current available treatment. This leaves a significant number of patients with uncontrolled disease and unmet need for additional therapies. Though many drug classes have been trialed for axSpA they show poor efficacy; however, over the last few years there are three which demonstrate much greater promise as novel therapies for axSpA, these include dual neutralization of IL-17A and IL-17F, Janus kinase (JAK) inhibitors, and granulocyte-macrophage colony-stimulating factor (GM-CSF) inhibitors. This article reviews the evidence for these novel emerging therapeutic options for axSpA.

Improving Rehabilitation Information-Giving to Intensive Care Unit Survivors to Aid in Physical and Psychological Recovery.

Intensive care unit (ICU) survivors have an increased mortality rate and reduced quality of life associated with post-ICU syndrome: a triad of physical, psychiatric and cognitive decline. Following evidence on the benefits of early rehabilitation, the National Institute of Clinical Excellence (NICE) CG83 guidelines instruct the provision of rehabilitation information to ICU patients before discharge. Only 33% of UK trusts meet these guidelines. The aim of this project was to reach 100% patient and ICU therapist satisfaction with the rehabilitation information given before ICU discharge at Medway Maritime Hospital, within four months. Patient and therapist satisfaction was assessed using questionnaires at baseline and following each Plan-Do-Study-Act (PDSA) cycle. In PDSA1, a generalised rehabilitation information booklet was created and distributed to ICU survivors pre-discharge. For PDSA2, a personalised rehabilitation plan completed by therapists was added. During PDSA3, the booklet was enriched with mental health and speech and language therapy sections. Results showed a shift in patient satisfaction scores, indicating a significant change in the median from 20% at baseline to 87% after PDSA3. This was also reflected in the therapist satisfaction scores, which increased significantly from 60% at baseline to 100%. The introduction of a generalised information booklet, supplemented with a personalised recovery plan, is an effective way of increasing critical care patient and therapist satisfaction with post-discharge rehabilitation information provision. This should translate to greater patient engagement with rehabilitation and improved long-term outcomes. This is ever more pertinent, as the COVID-19 pandemic will exponentially increase the numbers of ICU survivors at risk of long-term morbidity and mortality.

Digital health strategies in the war against COVID-19 and beyond.

This editorial explores how technology has helped clinicians during the COVID-19 pandemic, from patient care to education, the changes that have been made and the numerous exciting possibilities of where technology can amalgamate with health care.