Flesh-Kincaid Grade Level Research Articles

Patient education resources for oral mucositis: a google search and ChatGPT analysis.

Oral mucositis affects 90% of patients receiving chemotherapy or radiation for head and neck malignancies. Many patients use the internet to learn about their condition and treatments; however, the quality of online resources is not guaranteed. Our objective was to determine the most common Google searches related to "oral mucositis" and assess the quality and readability of available resources compared to ChatGPT-generated responses. Data related to Google searches for "oral mucositis" were analyzed. People Also Ask (PAA) questions (generated by Google) related to searches for "oral mucositis" were documented. Google resources were rated on quality, understandability, ease of reading, and reading grade level using the Journal of the American Medical Association benchmark criteria, Patient Education Materials Assessment Tool, Flesch Reading Ease Score, and Flesh-Kincaid Grade Level, respectively. ChatGPT-generated responses to the most popular PAA questions were rated using identical metrics. Google search popularity for "oral mucositis" has significantly increased since 2004. 78% of the Google resources answered the associated PAA question, and 6% met the criteria for universal readability. 100% of the ChatGPT-generated responses answered the prompt, and 20% met the criteria for universal readability when asked to write for the appropriate audience. Most resources provided by Google do not meet the criteria for universal readability. When prompted specifically, ChatGPT-generated responses were consistently more readable than Google resources. After verification of accuracy by healthcare professionals, ChatGPT could be a reasonable alternative to generate universally readable patient education resources.

Neural networks application based on language features in the classification of complex English textbooks granularity

The surge in modern information has led to a significant increase in text complexity. To meet the needs of various fields for effective information extraction, research on text complexity grading urgently is urgently needed. The study uses the Flesh-Kincaid Grade Level (FKGL) model to extract language features, selects English textbooks as training corpus, and introduces the Graph Convolutional Network of Attention Mechanism (GCN_ATT) model of attention mechanism to construct a text complexity grading model. The research results indicated that in the 10-fold crossover experiment, GCN_ATT’s accuracy, recall, and F1 all reached over 88%. Compared to multi class logistic regression models, GCN_ATT’s various performance indicators were approximately 2% to 3% higher. Meanwhile, GCN_ ATT’s F1 standard deviation decreased by 0.7% and 1.78% compared to the other two models. In addition, GCN_ATT’s fluctuation range of recall and accuracy was less than 20%, a decrease of 12% and 18% compared to the ordered multi classification regression model. Explanation based on GCN_ATT’s text complexity grading has higher accuracy and more stable performance, providing an effective method reference for current text complexity grading problems.

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

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. 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. 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. 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.

Chat Generative Pretraining Transformer Answers Patient-focused Questions in Cervical Spine Surgery.

Review of Chat Generative Pretraining Transformer (ChatGPT) outputs to select patient-focused questions. We aimed to examine the quality of ChatGPT responses to cervical spine questions. Artificial intelligence and its utilization to improve patient experience across medicine is seeing remarkable growth. One such usage is patient education. For the first time on a large scale, patients can ask targeted questions and receive similarly targeted answers. Although patients may use these resources to assist in decision-making, there still exists little data regarding their accuracy, especially within orthopedic surgery and more specifically spine surgery. We compiled 9 frequently asked questions cervical spine surgeons receive in the clinic to test ChatGPT's version 3.5 ability to answer a nuanced topic. Responses were reviewed by 2 independent reviewers on a Likert Scale for the accuracy of information presented (0-5 points), appropriateness in giving a specific answer (0-3 points), and readability for a layperson (0-2 points). Readability was assessed through the Flesh-Kincaid grade level analysis for the original prompt and for a second prompt asking for rephrasing at the sixth-grade reading level. On average, ChatGPT's responses scored a 7.1/10. Accuracy was rated on average a 4.1/5. Appropriateness was 1.8/3. Readability was a 1.2/2. Readability was determined to be at the 13.5 grade level originally and at the 11.2 grade level after prompting. ChatGPT has the capacity to be a powerful means for patients to gain important and specific information regarding their pathologies and surgical options. These responses are limited in their accuracy, and we, in addition, noted readability is not optimal for the average patient. Despite these limitations in ChatGPT's capability to answer these nuanced questions, the technology is impressive, and surgeons should be aware patients will likely increasingly rely on it.

Abstract TP56: Addressing Written Stroke Education and Post-Discharge Prescription Filling for Ischemic Stroke Survivors

Background: Poor adherence to prescribed medication and prescription filling can have dire consequences on patient outcomes. It is important that patients understand how their medications reduce the progression or worsening of their diagnosis. Understanding can be enhanced through literacy assessment and implementation of educational materials. At a CSC, it was identified that only 33% of Acute Ischemic Stroke (AIS) and TIA survivors filled new prescriptions within one week of being discharged home. Purpose To evaluate inpatient written stroke education book for its health and grade literacy, make targeted modifications, then assess its impact on prescription filling within one week of discharged home for stroke survivors. Methods: We conducted a pre-post design EBP QI project. The original and modified book was evaluated using the Patient Education Materials Assessment Tool (PEMAT) and the Flesh-Kincaid Grade Level (FKGL) tool. Based on these scores, targeted modifications were made to remove content, add infographics, and free text areas. The modified book was implemented in October 2023. Group one received the original book between Jan-May 2021, while group two received the modified book between November 2022-Jan 2023. Prescription filling rates were collected from post-discharge phone-call questionnaires and included AIS and TIA survivors, discharged home, > 18 years of age, and completed the phone call questionnaire. Mann-Whitney two-sample rank-sum test was completed to assess for statistical significance among groups. Statistical significance was set at 0.05. Results: Prior to the book revisions the FKGL was at the 11 th grade level, and the PEMAT scores indicated 55.3% understandability, and 56% actionability. Following modifications, the FKGL was at the 7 th grade level, and the PEMAT scores indicated 89.9% understandability and 95% actionability. The rate of prescriptions filled was evaluated pre (n= 98, 33%) and post modification (n=52, 56%) and was statistically significant (U= 1959, z=-2.73, p=0.006). Conclusion: Addressing the literacy and grade level of written stroke education improved prescription filling in AIS and TIA survivors discharged home. Further research may focus on additional barriers to prescription filling.

Differences Between Highly Rated vs Poorly Rated Patient Ratings of Radiology Reports

ObjectiveTo evaluate differences in quantitative features between poorly versus highly rated patient ratings of radiology reports. MethodsA HIPAA-compliant, IRB-waived study was performed from October 2019 to June 2021. Patients completed an optional 2-question survey (“How helpful was the report?” with a 5-star scale and an open text box) embedded into the patient portal, and reports were assessed for readability and brevity. Quantitative analyses were performed between poorly (≤3 stars) and highly rated (>3 stars) CT and MRI reports, including the use of structured reporting, number of words, words per sentence, Flesch Reading Ease, and Flesh-Kincaid Grade level within the findings and impression sections of the radiology reports. A two-tailed nonparametric Mann U Whitney test was performed for continuous variables and Chi2 for categorical variables. ResultsOf the 490 responses, all 135 evaluating CT or MR were included (27%). 106/135 (78%) of the patients gave high ratings (score of 4 or 5). 46/135 (34%), the radiology reports were in a structured format. The proportion of highly rated reports were significantly higher for structured than freeform reports (93.5 vs. 70.8%, p = 0.002). In the findings section, highly rated reports had a lower Flesch Reading Ease score than poorly rated reports (19.6 vs. 28.9, p <0.01). No significant differences were observed between number of words (p=0.27), words per sentence (p=0.94), and Flesh-Kincaid Grade level (p=0.09) in the findings section. In the impression section, no differences were observed between highly vs. poorly rated reports among the measured parameters. ConclusionPatients preferred highly rated reports that were structured and had lower Flesch Reading Ease scores in the findings section.

Large Language Model−Based Chatbot vs Surgeon-Generated Informed Consent Documentation for Common Procedures

Informed consent is a critical component of patient care before invasive procedures, yet it is frequently inadequate. Electronic consent forms have the potential to facilitate patient comprehension if they provide information that is readable, accurate, and complete; it is not known if large language model (LLM)-based chatbots may improve informed consent documentation by generating accurate and complete information that is easily understood by patients. To compare the readability, accuracy, and completeness of LLM-based chatbot- vs surgeon-generated information on the risks, benefits, and alternatives (RBAs) of common surgical procedures. This cross-sectional study compared randomly selected surgeon-generated RBAs used in signed electronic consent forms at an academic referral center in San Francisco with LLM-based chatbot-generated (ChatGPT-3.5, OpenAI) RBAs for 6 surgical procedures (colectomy, coronary artery bypass graft, laparoscopic cholecystectomy, inguinal hernia repair, knee arthroplasty, and spinal fusion). Readability was measured using previously validated scales (Flesh-Kincaid grade level, Gunning Fog index, the Simple Measure of Gobbledygook, and the Coleman-Liau index). Scores range from 0 to greater than 20 to indicate the years of education required to understand a text. Accuracy and completeness were assessed using a rubric developed with recommendations from LeapFrog, the Joint Commission, and the American College of Surgeons. Both composite and RBA subgroup scores were compared. The total sample consisted of 36 RBAs, with 1 RBA generated by the LLM-based chatbot and 5 RBAs generated by a surgeon for each of the 6 surgical procedures. The mean (SD) readability score for the LLM-based chatbot RBAs was 12.9 (2.0) vs 15.7 (4.0) for surgeon-generated RBAs (P = .10). The mean (SD) composite completeness and accuracy score was lower for surgeons' RBAs at 1.6 (0.5) than for LLM-based chatbot RBAs at 2.2 (0.4) (P < .001). The LLM-based chatbot scores were higher than the surgeon-generated scores for descriptions of the benefits of surgery (2.3 [0.7] vs 1.4 [0.7]; P < .001) and alternatives to surgery (2.7 [0.5] vs 1.4 [0.7]; P < .001). There was no significant difference in chatbot vs surgeon RBA scores for risks of surgery (1.7 [0.5] vs 1.7 [0.4]; P = .38). The findings of this cross-sectional study suggest that despite not being perfect, LLM-based chatbots have the potential to enhance informed consent documentation. If an LLM were embedded in electronic health records in a manner compliant with the Health Insurance Portability and Accountability Act, it could be used to provide personalized risk information while easing documentation burden for physicians.

Upper Limb Spasticity: The Quality of Online Patient Resources.

The aim of the study is to assess the quality, readability, content, accessibility, and structure of online resources for patients with upper limb spasticity. This was a cross sectional study examined Internet searches across three search engines related to patient resources for upper limb spasticity. Search phrases for either hand or upper limb spasticity were used. The top 20 Websites from each search were evaluated using the four readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software. Thirty-six Websites and 33 videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the Websites was 11.7 ± 3.1, showing low Website readability. According to this index, only two Websites were written at the suggested sixth-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both Websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively. Current online resources for upper limb spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.

The Capability of ChatGPT in Predicting and Explaining Common Drug-Drug Interactions.

Background Drug-drug interactions (DDIs) can have serious consequences for patient health and well-being. Patients who are taking multiple medications may be at an increased risk of experiencing adverse events or drug toxicity if they are not aware of potential interactions between their medications. Many times, patients self-prescribe medications without knowing DDI. Objective The objective is to investigate the effectiveness of ChatGPT, a large language model, in predicting and explaining common DDIs. Methods A total of 40 DDIs lists were prepared from previously published literature. This list was used to converse with ChatGPT with a two-stage question. The first question was asked as "can I take X and Y together?" with two drug names. After storing the output, the next question was asked. The second question was asked as "why should I not take X and Y together?" The output was stored for further analysis. The responses were checked by two pharmacologists and the consensus output was categorized as "correct" and "incorrect." The "correct" ones were further classified as "conclusive" and "inconclusive." The text was checked for reading ease scores and grades of education required to understand the text. Data were tested by descriptive and inferential statistics. Results Among the 40 DDI pairs, one answer was incorrect in the first question. Among correct answers, 19 were conclusive and 20 were inconclusive. For the second question, one answer was wrong. Among correct answers, 17 were conclusive and 22 were inconclusive. The mean Flesch reading ease score was 27.64±10.85 in answers to the first question and 29.35±10.16 in answers to the second question, p = 0.47. The mean Flesh-Kincaid grade level was 15.06±2.79 in answers to the first question and 14.85±1.97 in answers to the second question, p = 0.69. When we compared the reading levels with hypothetical 6th grade, the grades were significantly higher than expected (t = 20.57, p < 0.0001 for first answers and t = 28.43, p < 0.0001 for second answers). Conclusion ChatGPT is a partially effective tool for predicting and explaining DDIs. Patients, who may not have immediate access to the healthcare facility for getting information about DDIs, may take help from ChatGPT. However, on several occasions, it may provide incomplete guidance. Further improvement is required for potential usage by patients for getting ideas about DDI.

Quality and readability of online information about root canal treatment and its outcomes: an infodemiological study

Root canal treatment, also known as endodontic treatment, is a common dental procedure that involves the removal of inflamed or infected pulp tissue, followed by cleaning, disinfecting, filling, and sealing the canals. The aim of this study is to categorize the content and assess the quality and readability of the online information regarding root canal treatment and related outcomes. An online search using three different terms regarding the root canal treatment and related outcomes was undertaken using Google, Yahoo, and Bing search engines. The first 100 websites that appeared in each search were analyzed. Data recorded included DISCERN instrument scores, Journal of the American Medical Association (JAMA) benchmarks, and the presence of the health on the net seal (HON). Flesh reading ease scores, flesh-kincaid grade level, the simplified measure of Gobbledygook index, and the Coleman-Liau index were calculated to assess readability. Eighty-five of the first websites remained for analysis after applying appropriate exclusion criteria. The mean overall DISCERN score was 2.91 (+1.12). Only one website (1.17%) achieved all four JAMA benchmarks. Only 12 websites (14.1%) displayed the HON seal. The reading level varied from standard to difficult among the majority of websites. Based on this study, the online information regarding root canal treatment and related outcomes has challenging readability with content of poor quality. Further efforts should be made to create and maintain high-quality, reliable, and easily readable online information sources related to root canal treatment outcomes.

The Risks Associated With Computed Tomography Scans: An Assessment of the Readability and Reliability of Online Text Available for Patient Information and Guidance.

Introduction Computed tomography (CT) scanninghas become a fundamental aspect of many diagnostic pathways and therapeutic procedures. However, it is not without risk. Many patients are unaware of the exposure to ionising radiation that is involved with undergoing a CT scan, as well as the associated increase in cancer risk with cumulative exposure. Controversy over which clinician is responsible for advising a patient regarding CT risk often means that patients are left uninformed and unaware. Those who choose to seek further guidance online do so with the risk of encountering poor quality, difficult-to-read medical text, which may leave them even more confused or misinformed. Aim This study aimed to assess the readability, quality, and accuracy of the information available to patients online regarding CT scans and their associated risks. Method An internet search of 180 websites was collated using three search terms, each entered into three search engines. The terms used were 'CT Risk', 'CT Harm', and 'Dangers of a CT Scan'. Unique websites generated were assessed for readability using four readability formulae: The Flesh-Kincaid Grade Level, the Flesch Reading Ease Score, the Gunning Fog Index, and the Simple Measure of Gobbledygook (SMOG) Index. The text on each website was also evaluated for quality and accuracy using the Discern tool. Mean readability scores were calculated and compared against the defined standard required for the information intended for the general public. A two-tailed t-test was also carried out to assess statistical significance. Results Of the 180 websites collated, 77 were unique.76.62% of websites (59/77) met the readability target for the Flesch-Kincaid Grade Level, and 66.23% (51/77) met the target for the Gunning Fog Index, which was for text to be readable at the Grade 8 level (or by children aged 13-14). 59.74% (46/77) met the target for the SMOG Index, which for healthcare information, was defined as Grade 6 Level, or children aged 11-12. Only 11.69% of websites (9/77) met the target for the Flesch Reading Ease score. 55.84%of websites satisfied the pre-defined standard for three out of four readability criteria, however, only 11.69% satisfied all four criteria, limited by the scores obtained by the Flesch Reading Ease formula. The websites generated a mean Discern score of 3.58, meaning the average quality of the information was deemed to be 'fair', with no serious shortcomings. Conclusion More than 50% of websites satisfied three readability criteria simultaneously. However, there is still scope for improvement, both in terms of enhancing the readability of the remaining websites, and also ensuring that all websites review the proportion of polysyllabic words in the text, which is the emphasis of the Flesh Reading Ease Score.In addition, physicians and radiologistshave a responsibility to inform patients of the risks associated with CT scans, and to direct them to supplementary good-quality information and resources.

Readability levels and thematic content analysis of online and printed lead poisoning informational materials

BackgroundLead poisoning prevention efforts include preparing and disseminating informational materials such as brochures and pamphlets to increase awareness of lead poisoning, lead exposures and lead poisoning prevention. However, studies have demonstrated that patient education materials for diseases and health conditions are prepared at a reading level that is higher than the recommended 7th–8th grade reading level. This study, therefore, aims to assess the reading levels of lead poisoning informational materials.MethodsLead poisoning materials (N = 31) were accessed from three states; Michigan, New York and Pennsylvania. The readability levels of the materials were assessed using the Flesh Kincaid Grade Level readability test. The Kruskal-Wallis test was conducted to determine if the readability levels differed between the materials obtained from the different states. Thematic content analyses were carried out to assess the inclusion of four themes; definition of lead poisoning, risk factors and exposures, testing and referral and prevention covering 12 subtopics. The Wilcoxon rank sum test was used to examine if there was a difference in the number of subtopics by readability level (dichotomized to >8th grade and < 8th grade).ResultsThe median readability level of the informational materials was 6.7 (IQR: 5.1–8.1). However, there was variability in the readability levels of the materials (range 3.5 to 10.6); materials obtained from Michigan had the highest median reading level of 8.1 (IQR: 6.9–9.0) followed by Pennsylvania. Heterogeneity was observed in the content of the materials. Most of the materials (80%) from Michigan focused on water as a source of lead poisoning, whereas materials from New York and Pennsylvania focused on lead-based paint and other sources. The materials prepared at >8th grade reading level contained fewer topics than materials prepared at <8th grade reading level.ConclusionsWe find that the materials were often prepared at reading levels lower than the recommended 8th grade reading level. However, there is variability in the reading levels and in the content of the materials. While the materials met the general readability guidelines, they did not necessarily meet the needs of specific groups, especially groups at risk.

The Patient Perspective: Evaluating the Accessibility of Transoral Robotic Surgery Online Resources.

The varied treatment options available to patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) can cause significant patient confusion. In particular, transoral robotic surgery (TORS) has become widely used for treatment of HPV-positive OPSCC. As patients commonly refer to the internet for additional information, we aim to evaluate the quality of online patient educational materials for TORS in comparison to other otolaryngology surgical procedures. The terms "transoral robotic surgery," "glossectomy," "thyroidectomy," and "neck dissection" were searched on Google. Flesch reading ease, Flesh-Kincaid Grade Level, MD review rates, and PEMAT understandability and actionability were assessed for each search term. Google trends was used to determine search interest for each term between May 2015 and May 2020. Of the 30 TORS websites that met inclusion criteria, the average FRE and FKGL scores were 40.74 and 11.60 (that of an average high school senior). The FRE and FKGL scores for TORS were all statistically significantly lower than those of all comparator search terms (P < .05). Only 1 out of 30 TORS sites were MD reviewed, representing the lowest MD review rate across all search terms. Understandability and actionability scores for TORS were also the lowest across all search terms at 77.71% and 2.66%, respectively. TORS had the lowest search interest. In comparison to other common otolaryngology procedures, TORS websites are the least patient friendly. As TORS becomes a more widely used procedure, it is critical that TORS websites become higher quality resources that patients can reliably reference.

Online educational materials for appendectomy patients have good quality but poor readability

BackgroundGuidelines recommend patient health-related information be written at or below the sixth-grade level. This study evaluates the readability level and quality of online appendectomy patient education materials. MethodsWebpages were evaluated using seven readability formulae: Flesh-Kincaid Grade Level (FKGL), Gunning Fog 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 quality using the Brief DISCERN tool. ResultsThirty seven webpages were analyzed. The mean readability scores were: FKGL = 9.11, GFI = 11.82, CLI = 10.84, ARI = 7.99, SMOG = 11.88, FRE = 51.17, and NDC = 5.48. 6 of the 7 readability formulae indicate that the materials were written at too high a level. The average Brief DISCERN score was 17.81, indicating good quality. ConclusionsReadability levels for online appendectomy patient education materials are higher than recommended but are of good quality. Authors of such materials should not only provide good quality information but also ensure readability.

Readability, content, and quality of COVID-19 patient education materials from academic medical centers in the United States

BackgroundSARS-CoV-2 has spread rapidly resulted in a global pandemic and public health crisis. The internet is a frequently used resource for providing patient education materials (PEMs). The aim of this study was to evaluate the readability, content, and quality of web-based PEMs on COVID-19 from US academic medical centers.MethodsThe names of US medical schools were obtained from the Association of American Medical Colleges website (n = 145). Institutional, hospital, and heath encyclopedia websites associated with each schools’ medical center were identified using Google. Readability of COVID-19 PEMs was calculated using three validated indices: (1) Flesh-Kincaid Grade Level, (2) Simple Measure of Gobbledygook, and (3) Gunning Frequency of Gobbledygook. Content was evaluated using a scoring matrix based on materials available on the Center for Disease Control website. The Patient Education Material Assessment Tool for Print (PEMAT-P) was used to assess usability and actionability.ResultsA total of 141 (97%) PEMs met inclusion criteria and were analyzed for readability, content, and quality. The mean readability was above the recommended sixth grade reading level (P < .001). Content was variable across PEMs. The PEMAT-P scores reflected good understandability with a median score of 83% (IQR 75%-87%), while actionability was poor with a median score of 41% (IQR 40%-60%).ConclusionsDespite availability of web-based PEMs for COVID-19, the readability was significantly higher than the National Institute of Health and US Department of Health and Human Services recommended sixth grade reading level and actionability of PEMs was low. It is critical to provide readable PEMs on COVID-19 to effectively disseminate accurate information and facilitate patients’ understanding of the virus, how it spreads, and how to protect themselves.

Readability and understandability of clinical research patient information leaflets and consent forms in Ireland and the UK: a retrospective quantitative analysis

ObjectivesThe first aim of this study was to quantify the difficulty level of clinical research Patient Information Leaflets/Informed Consent Forms (PILs/ICFs) using validated and widely used readability criteria which provide...

Health literacy among neurosurgery and other surgical subspecialties: Readability of online patient materials found with Google

ObjectiveTo both determine whether the most high-yield online patient materials for surgical specialties meet the 6th grade readability level recommended by the National Institutes of Health (NIH) and American Medical Association (AMA), and to discover differences in readability across specialties. We hypothesize average readability scores will exceed an 11th grade level. MethodsThe top five most common procedures for each of seven surgical specialties (neurological, orthopedic, plastic, general, thoracic, pediatric, and vascular) were searched using an incognito Google query to minimize location bias. The text from the top five patient-relevant links per procedure, excluding Wikipedia, journal articles, and videos, was extracted and inserted into Readability Studio Software for analysis. ResultsThe combined average grade level of materials (± standard deviation) was: 10.47 ± 2.51 Flesh-Kincaid Grade Level (FKGL), 11–12 New Dale-Chall (NDC), 10.09 ± 1.97 Simple Measure of Gobbledygook (SMOG), 12 Fry Graph (FG). Thoracic, neurologic, vascular, plastic, and orthopedic were least readable (grade level 10+ by all metrics). ConclusionsHigh readability of procedure materials for patients is not unique to neurosurgery: all specialties exceeded the recommended 6th grade level by three or more grades. Online patient education materials related to surgical subspecialties must be written more comprehensibly.

Readability assessment of self-report hyperacusis questionnaires

Objective: To assess the overall readability of five currently available hyperacusis questionnaires and to assess the variability of single items within each questionnaire.Design: Comparative study of self-report hyperacusis questionnaires: (1) Geräuschüberempfindlichkeits-Fragebogen (GUF), (2) Noise Avoidance Questionnaire (NAQ), (3) Hyperacusis Questionnaire (HQ), (4) Sound Sensitive-Tinnitus Index (SSTI), and (5) Inventory of Hyperacusis Symptoms (IHS). Well-established readability formulas Flesh-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), Simple Measure of Gobbledygook (SMOG) and FORCAST and a computerised readability calculation software were used.Study sample: Five questionnaires.Results: Reading levels calculated by each formula varied for every questionnaire. Readability scores ranged from 7.7th to 12.7th grade for overall readability depending on the questionnaire. This exceeded the grade reading levels of 5th–6th grade (10–12 years old) as recommended by the American Medical Association or 7th–8th grade (12–14 years old) as recommended by the US National Institutes of Health. Single item readability analysis based on FKGL revealed that 32%–70% of single items are written above the recommended grade levels.Conclusion: All five questionnaires are written at close to or exceeding the recommended grade levels. This requires attention from developers but also when interpreting the questionnaire scores obtained in clinic.

A fountain of knowledge? The quality of online resources for testicular cancer patients.

Testicular cancer is the most common solid malignancy diagnosed in young men aged 15-29. This population is also the age group that searches most actively for health information online. This study systematically evaluates the quality of websites available to patients with testicular cancer. The term "testicular cancer" was inputted into the search engines Google, Dogpile, and Yippy. The top 100 websites intended for patient education were compiled. A validated structural rating tool was used to evaluate the websites with respect to attribution, currency, disclosure, interactivity, readability, and content. Less than half of the websites (44) disclosed authorship. Sixty-one websites provided a last modified date, and of those, 46 were updated in the last two years. The average readability level was 11.01 using the Flesh-Kincaid grade level system. The most accurate topic was treatment, with 82 websites being completely accurate and containing all required information. The least accurate topic was prognosis, with 27 being completely accurate. These results show that authorship and currency are lacking in many online testicular resources, making it difficult for patients to validate the reliability of information. The high average readability of testicular cancer websites can affect comprehension. Topics such as prognosis were incompletely covered although represent an area for which patients often seek more information. These results can be used to counsel patients on the strength and weaknesses of online testicular cancer resources.

Information for oral and maxillofacial patients: can it be improved?

The aim and objective of this study was to evaluate the quality and readability of leaflet and online Oral and Maxillofacial Surgery patient information leaflets (PILs). The quality, readability and grade level of each PIL was assessed using the DISCERN, Flesch Reading Ease and Flesh-Kincaid Grade Level instruments respectively. In total, 140 patient information leaflets were assessed. For both leaflet and online PILs, many items of the DISCERN instrument were deemed of low quality and poorly reported. The median overall quality score was 30.2. Variation in the quality and readability scores between leaflet and online PILs and those produced by various societies was evident. Overall, PILs were deemed to be of moderate quality. Online PILs were of lower quality, more difficult to read and aimed at a higher reading age level.