Quality and readability of online health information on menopausal hormone therapy in Canada: what are our patients reading?

OBJECTIVE: To assess the quality and readability of 24 of the most accessed menopause hormone therapy (MHT) websites by Canadian women. METHODS: The top 24 websites from Google, Bing, and Yahoo were identified using the search term "hormone replacement therapy." Five menopause specialists assessed website content quality using the DISCERN Instrument, Journal of the American Medical Association (JAMA) benchmarks, and Abbott's Scale. Two reviewers assessed website credibility using the Health on the Net Foundation Code of Conduct certification, and website readability using the Simple Measure of Gobbledygook, Flesch-Kincaid Grade Level, and Flesch-Kincaid Read Ease formulae. RESULTS: Scores for quality of information varied. The mean JAMA score was low at 2.3 ±â€Š1.1 (out of 4). Only one website met all benchmarks. Fourteen websites (58%) had a good/excellent DISCERN score, while four (17%) had a poor/very poor score. For Abbott's Scale, both the mean authorship score at 2.2 ±â€Š1.0 (out of 4) and mean content score at 45.9 ±â€Š9.8 (out of 100) were low. Inter-rater reliability was high for all tools. Fifteen websites (63%) were Health on the Net Foundation Code of Conduct certified. The mean Flesch-Kincaid Read Ease was 42.7 ±â€Š10.3, mean Flesch-Kincaid Grade Level was 12.3 ±â€Š1.9, and mean Simple Measure of Gobbledygook grade level was 11.3 ±â€Š1.5. Only one website presented content at a reading level recommended for the public. Websites meeting more JAMA benchmarks were significantly less readable (P < 0.05). CONCLUSION: Although good quality MHT information exists online, several resources are inaccurate or incomplete. Overall, these resources are not considered comprehensible by the public. There is a need to disseminate accurate, comprehensive, and understandable MHT information online.

Survey of Canadian PGY-4 and PGY-5 Obstetrics and Gynaecology Residents on Knowledge of and Exposure to Premature Ovarian Insufficiency.

OBJECTIVES: (1) To determine exposure to and general knowledge on premature ovarian insufficiency (POI) among Canadian senior obstetrics and gynaecology residents. (2) To identify opportunity to improve trainee exposure to POI. METHODS: Canadian PGY-4 and PGY-5 obstetrics and gynaecology residents were approached to complete an electronic survey. The questions in the survey included the basic POI knowledge, previous exposure to POI, and comfort level in managing POI patients. Data from the survey was summarized descriptively and compared between two trainee groups (PGY-4 and PGY-5) using chi-square or Fisher exact tests. RESULTS: Responses were received from trainees in all Canadian residency programs with an overall response rate of 45% (95/210 residents). Most respondents (79%, 75/95 residents) identified correct age for POI diagnosis, and 65% (62/95 residents) recognized the most common aetiology. A majority (99%, 92/93 residents) would prescribe hormone therapy for POI patients. Most trainees (62%, 59/95 residents) lack access to a POI clinic at their centre and 63% (59/94 residents) have seen less than six POI patients during residency training. Most feel somewhat comfortable managing POI patients (67%, 64/95 residents), but 22% (21/95 residents) feel totally uncomfortable with a majority of respondents (83%, 78/94 residents), indicating they would benefit from additional training. Compared with PGY-4 residents, the proportion of trainees who could identify the correct age for diagnosis of POI was significantly higher in PGY-5 residents (89% vs. 70%, P = 0.024). CONCLUSION: Many senior obstetrics and gynaecology residents in Canada lack knowledge around POI, and most indicate need for further exposure to POI during residency training. We identified an opportunity for improved POI curricula.

Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy.

OBJECTIVE: Because of concerns about uterine rupture, many obstetricians recommend elective Caesarean section for women with a prior myomectomy. This practice has led to an increased rate of elective CS and subsequently of repeat Caesarean sections. The purpose of this study was to evaluate the perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy. METHODS: We conducted a survey of 49 practising obstetricians from July 2012 to January 2013, using a standard questionnaire. This included questions on labour and delivery after myomectomy by laparotomy or laparoscopy. RESULTS: Overall, the inter-respondent agreement was fair (kappa 0.3; P < 0.001). There was no significant difference in the likelihood that respondents would allow vaginal delivery after myomectomy by laparotomy and by laparoscopy (27% and 14% if the uterine cavity was entered and 76% and 71% if the uterine cavity was not entered, respectively). However, the likelihood that respondents would allow vaginal delivery was significantly reduced if the uterine cavity was entered, regardless of the surgical approach (P < 0.001). Entry into the uterine cavity during myomectomy also significantly increased the likelihood that obstetricians would recommend elective CS rather than induction of labour. There was no significant difference in practice regarding the use of oxytocin with amniotomy, oxytocin infusion, or prostaglandins. CONCLUSION: Despite a lack of evidence, obstetricians consider entry into the uterine cavity at myomectomy to be an important factor in determining the method of delivery, the use of oxytocin, and delivery by elective Caesarean section. This was independent of the myomectomy approach.

Objectif : En raison de préoccupations au sujet de la rupture utérine, de nombreux obstétriciens recommandent la tenue d'une césarienne planifiée pour ce qui est des femmes ayant déjà subi une myomectomie. Cette pratique a mené à la hausse du taux de césarienne planifiée et, subséquemment, à celle du taux de césarienne itérative. Cette étude avait pour objectif d'évaluer les points de vue des obstétriciens en ce qui concerne le travail et l'accouchement à la suite d'une myomectomie abdominale ou laparoscopique. Méthodes : Nous avons mené un sondage auprès de 49 obstétriciens praticiens, entre juillet 2012 et janvier 2013, au moyen d'un questionnaire standard. Ce dernier comptait des questions sur le travail et l'accouchement à la suite d'une myomectomie menée par laparotomie ou par laparoscopie. Résultats : De façon globale, le consensus inter-répondants était assez bon (kappa 0,3; P < 0,001). Aucune différence significative n'a été constatée en ce qui concerne la probabilité que les répondants permettent la tenue d'un accouchement vaginal à la suite d'une myomectomie menée par laparotomie ou par laparoscopie (27 % et 14 %, si la cavité utérine avait été pénétrée, et 76 % et 71 %, si la cavité utérine n'avait pas été pénétrée, respectivement). Cependant, la probabilité que les répondants permettent la tenue d'un accouchement vaginal était considérablement atténuée lorsque la cavité utérine avait été pénétrée, peu importe l'approche chirurgicale utilisée (P < 0,001). La probabilité que les obstétriciens recommandent la tenue d'une césarienne planifiée, plutôt que celle d'un déclenchement du travail, connaissait également une hausse significative lorsque la cavité utérine avait été pénétrée au cours de la myomectomie. Aucune différence significative n'a été constatée au niveau de la pratique en ce qui concerne l'utilisation d'oxytocine conjointement avec une amniotomie, d'oxytocine en perfusion ou de prostaglandines. Conclusion : Malgré le manque de données sur le sujet, les obstétriciens considèrent que la pénétration de la cavité utérine pendant la myomectomie (et ce, peu importe l'approche chirurgicale utilisée dans le cadre de cette dernière) constitue un facteur important au moment de prendre des décisions quant au mode d'accouchement, à l'utilisation d'oxytocine et au recours à une césarienne planifiée.