Kincaid Grade Level Research Articles

Exploring the Utility of ChatGPT in Cleft Lip Repair Education

Background/Objectives: The evolving capabilities of large language models, such as generative pre-trained transformers (ChatGPT), offer new avenues for disseminating health information online. These models, trained on extensive datasets, are designed to deliver customized responses to user queries. However, as these outputs are unsupervised, understanding their quality and accuracy is essential to gauge their reliability for potential applications in healthcare. This study evaluates responses generated by ChatGPT addressing common patient concerns and questions about cleft lip repair. Methods: Ten commonly asked questions about cleft lip repair procedures were selected from the American Society of Plastic Surgeons’ patient information resources. These questions were input as ChatGPT prompts and five board-certified plastic surgeons assessed the generated responses on quality of content, clarity, relevance, and trustworthiness, using a 4-point Likert scale. Readability was evaluated using the Flesch reading ease score (FRES) and the Flesch–Kincaid grade level (FKGL). Results: ChatGPT responses scored an aggregated mean rating of 2.9 out of 4 across all evaluation criteria. Clarity and content quality received the highest ratings (3.1 ± 0.6), while trustworthiness had the lowest rating (2.7 ± 0.6). Readability metrics revealed a mean FRES of 44.35 and a FKGL of 10.87, corresponding to approximately a 10th-grade literacy standard. None of the responses contained grossly inaccurate or potentially harmful medical information but lacked citations. Conclusions: ChatGPT demonstrates potential as a supplementary tool for patient education in cleft lip management by delivering generally accurate, relevant, and understandable information. Despite the value that AI-powered tools can provide to clinicians and patients, the lack of human oversight underscores the importance of user awareness regarding its limitations.

Assessment of the quality, reliability, and readability of the websites about orthognathic surgery

Objectives: The purpose of this study is to evaluate the accuracy, dependability, and readability of websites providing information about orthognathic surgery. Material and Methods: A total of 300 websites encountered through Google, Yahoo, and Bing search engines using the search terms “orthognathic surgery” and “jaw surgery” were utilized. Websites containing duplicate advertisements, original articles, or course content with video links unrelated to the topic were excluded from the study. Ninety-three websites were included in the study. The included websites were assessed for reliability and quality using the DISCERN, Ensuring Quality Information for Patients (EQIP), and Journal of American Medical Association (JAMA) tools. Readability was evaluated by determining the Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL) scores. The data that did not show normal distribution were analyzed using the Kruskal–Wallis test. Post hoc comparisons were conducted using the least significant difference and Mann– Whitney U-tests. A significance level of P < 0.05 was accepted. Results: The mean DISCERN score was (38.47 ± 10.47), the EQIP score was (57.34 ± 10.73), and the JAMA score was (0.81 ± 0.99). The FRES was determined to be (43.89 ± 11.36), and the FKGL score was (12.06 ± 2.3). In the layperson group, the highest scores were found in the DISCERN (44.62 ± 9.73) and JAMA (1.85 ± 0.8) analyses compared to other groups. Conclusion: Website content on orthognathic surgery is generally of poor quality, and moderate reliability, with readability often being challenging for the average reader. There is a need for more user-friendly websites that offer comprehensive and easily digestible information to better serve orthognathic surgery patients.

Can people with epilepsy trust AI chatbots for information on physical exercise?

PurposeThis study aims to evaluate the similarity, readability, and alignment with current scientific knowledge of responses from AI-based chatbots to common questions about epilepsy and physical exercise. MethodsFour AI chatbots (ChatGPT-3.5,ChatGPT 4, Google Gemini, and Microsoft Copilot) were evaluated. Fourteen questions on epilepsy and physical exercise were designed to compare the platforms. Lexical similarity, response patterns, and thematic content were analyzed. Readability was measured using the Flesch Reading Ease and Flesch–Kincaid Grade Level scores. Seven experts rated the quality of responses on a Likert scale from “very poor” to “very good.” ResultsThe responses showed lexical similarity, with approaches to physical exercise ranging from conservative to holistic. Microsoft Copilot scored the highest on the Flesch Reading Ease scale (48.42 ± 13.71), while ChatGPT-3.5 scored the lowest (23.84 ± 8.19). All responses were generally rated as difficult to read. Quality ratings ranged from “Good” to “Acceptable,” with ChatGPT 4 being the preferred platform, chosen by 48.98 % of reviewers. ConclusionThe findings highlight the potential of AI chatbots as useful sources of information on epilepsy and physical exercise. However, simplifying language and tailoring content to user’s needs is essential to enhance their effectiveness.

Comparative Readability Assessment of Four Large Language Models in Answers to Common Contraception Questions [ID 2683638

INTRODUCTION: Large language models (LLMs) have the potential to revolutionize reproductive health education by offering accessible contraception counseling. The CDC, NIH, and AMA recommend presenting patient educational materials at or below a sixth-grade reading level. In this study, we present a comparative analysis of the readability of responses generated by LLMs, including OpenAI's ChatGPT 4.0, OpenAI's ChatGPT 3.5, Google Bard, and Microsoft Bing, to common contraception questions. METHODS: Referencing common contraception questions outlined in a recent review, we presented GPT-4.0, GPT-3.5, Google Bard, and Microsoft Bing with six common contraception questions on June 10, 2023, ensuring no prior chat bias. The readability of LLM outputs was evaluated using Flesch–Kincaid Grade Level (FK), Gunning Fog (GF), Automated Readability Index (ARI), and Coleman–Liau (CL) indices. All index score outputs correspond to a reading grade level (RGL), eg, RGL of 6 represents a sixth-grade level. RESULTS: Of the four LLMs, Google Bard demonstrated the highest readability with an average RGL of 10.6 (GF 10.1, FK 9.6, ARI 11.4, CL 11.4), followed by GPT-3.5 at an average RGL of 13.6 (GF 13.3, FK 12.6, ARI 15.2, CL 16.5). Microsoft Bing and GPT-4.0 yielded responses with higher average RGLs of 14.2 and 15.4, respectively. CONCLUSION: Google Bard and GPT-3.5 offered the most readable responses to contraception questions; however, these models still provided responses significantly above the recommended sixth-grade reading level (RGL of 6). Large language models should undergo evaluation to ensure alignment with established readability standards to optimize patient comprehension in reproductive counseling applications.

Pregnancy Loss: A Comparative Analysis of Information Delivery Between ACOG FAQs and ChatGPT [ID 2683594

INTRODUCTION: Pregnancy loss is a sensitive topic, and clear, reliable information is crucial. This study compares the readability and accuracy of ChatGPT's responses to ACOG's frequently asked questions (FAQ) sheets on the subject. METHODS: Within the five FAQ sheets under “Pregnancy Loss,” 66 questions were assessed using ChatGPT-3.5. Readability scores, ie, Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index were computed for each response. The quality of responses were also graded by two maternal–fetal medicine specialists using a 1–4 scale, where 1 represents a comprehensive response and 4 indicates an incorrect response. Statistical analysis utilized a two-tailed t-test. A weighted Cohen’s kappa coefficient evaluated interrater reliability. RESULTS: ACOG attained better readability scores over ChatGPT across all six metrics with statistical significance (P<.001). Among grading, ACOG also outperformed ChatGPT in quality of information with a summative mean of 1.53 (SD 0.60) versus 1.85 (SD 0.90) with statistical significance (P<.001). Grading for ACOG possessed a Cohen's kappa coefficient of 0.493, implying moderate agreement between graders. Grading for ChatGPT possessed a Cohen's kappa coefficient of 0.744, implying substantial agreement between graders. CONCLUSION: The responses by ACOG to frequently asked questions on pregnancy loss were both clearer and more comprehensive than those of ChatGPT with consistent agreement between graders. Although ChatGPT can be a convenient source of medical queries, further improvements ought to be made to these large-language models to provide clear and accurate information regarding pregnancy loss to patients.

Changing Health Information on COVID-19 Vaccination in Asia

The informational domain related to COVID-19 reflects the degree of uncertainty and pace of evolution of the pandemic. This places a burden on peoples’ searches for information to guide their choices, importantly including for COVID-19 vaccines. Thus, it is important for health communications that support vaccination campaigns to attenuate vaccine hesitancy to be accessible, including in terms of readability, and adapted to the evolving pandemic. This paper aims to understand internet searches on COVID-19 vaccination, specifically the mix of sources and readability of the sources over a two-year period (2021–2023) in Singapore, Hong Kong, and the Philippines, for search results in English, as English is a main language for each of these locations. The sources accessed through online searches in June 2021 and May 2023 were categorized by type of source and whether they were from one of the focal locations or elsewhere. The readability of information from web-search results was assessed using a set of readability tests (Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Index, Coleman–Liau Index, and Simple Measure of Gobbledygook Grade level). Over the two-year period there was an increase in government sources and reduction in mass media sources with distinct local patterns. Local government sources increased in Singapore whereas foreign government and multi-lateral organization sources increased in Hong Kong, with the Philippines being an intermediate pattern. In contrast to the changing mix of sources, the readability tests indicate a low proportion of URLs scoring within recommended readability thresholds across locations and types of sources over the two years. Information on COVID-19 vaccine development and deployment is an important part of health communications that includes internet search. The paper contributes to understanding health communications during a pandemic, including mix of local and non-local sources and contingency on local social and health context.

Quality assessment of available Internet information on early orthodontic treatment

BackgroundThis study aimed to evaluate the content, reliability, quality and readability of information on Internet websites about early orthodontic treatment.MethodsThe “early orthodontic treatment” search term was individually entered into four web search engines. The content quality and reliability were reviewed with DISCERN, Journal of American Medical Association (JAMA), and Health on the Net code (HONcode) tools using the contents of websites meeting predetermined criteria. The readability of websites was evaluated with Flesch Reading Facilitate Score (FRES) and Flesch–Kincaid Grade Level (FKGL).ResultsEighty-six websites were suitable for inclusion and scoring of the 200 websites. 80.2% of websites belonged to orthodontists, 15.1% to multidisciplinary dental clinics and 4.7% to professional organizations. The mean DISCERN score of all websites (parts 1 and 2) was 27.98/75, ranging between 19 and 67. Professional organization websites had the highest scores for DISCERN criteria. Moreover, 45.3% of websites were compatible with JAMA’s disclosure criterion, 7% with the currency criterion, 5.8% with the authorship criterion and 5.8% with the attribution criterion. Only three websites met all JAMA criteria, and these websites belonged to professional organizations. None of the websites had the HONcode logo. Mean FRES and FKGL were 47.6 and 11.6, respectively.ConclusionsThe quality of web-based information about early orthodontic treatment is poor, and readability is insufficient. More accurate and higher quality Internet sources are required on the web.

Development and Validation of Patient Information Leaflet for Schizophrenia

Abstract Context: People with severe mental illnesses like schizophrenia demonstrate a high rate of therapeutic noncompliance in contrast to other forms of mental illnesses. Educating patients regarding the disease and treatment helps to overcome the barriers of their resistance toward the prescribed regimen. Numerous tools have been developed for educating patients and the most convenient and cost-effective form of educational tool is a leaflet. Aims: The study aims to develop and validate a patient information leaflet (PIL) for patients with schizophrenia. Methods: The PIL contents were generated from various sources of literature and discussion with several experts in the fields of psychiatry, dietetics, and pharmacy, followed by validation using the content validation index (CVI) method. The Flesch reading ease (FRE) and Flesch–Kincaid Grade Level (FKGL) formulas were employed to assess readability and evaluate layout and design, Baker-Able Leaflet Design (BALD) criteria were utilized. Results: The prepared draft PIL obtained CVI scores of 0.94 (relevance) and 0.84 (clarity), indicating good content validity. The readability scores 74.4 (FRE) and 4 (FKGL) denoted that the textual contents in the PIL are relatively easy to read by any person with an educational grade of four and above. The BALD scores of 29 (English) and 26 (Malayalam and Kannada) represent the PIL good layout and design. Conclusion: A draft PIL for patients with schizophrenia is prepared and validated. Further user-testing analysis is needed to evaluate the PIL’s efficiency in the target population.

Artificial Intelligence Language Model Performance for Rapid Intraoperative Queries in Plastic Surgery: ChatGPT and the Deep Inferior Epigastric Perforator Flap

Background: The integration of artificial intelligence in healthcare has led to the development of large language models that can address various medical queries, including intraoperatively. This study investigates the potential of ChatGPT in addressing intraoperative questions during the deep inferior epigastric perforator flap procedure. Methods: A series of six intraoperative questions specific to the DIEP flap procedure, derived from real-world clinical scenarios, were proposed to ChatGPT. A panel of four experienced board-certified plastic surgeons evaluated ChatGPT’s performance in providing accurate, relevant, and comprehensible responses. Results: The Likert scale demonstrated to be medically accurate, systematic in presentation, and logical when providing alternative solutions. The mean readability score of the Flesch Reading Ease Score was 28.7 (±0.8), the Flesch–Kincaid Grade Level was 12.4 (±0.5), and the Coleman–Liau Index was 14.5 (±0.5). Suitability-wise, the DISCERN score of ChatGPT was 48 (±2.5) indicating suitable and comprehensible language for experts. Conclusions: Generative AI tools such as ChatGPT can serve as a supplementary tool for surgeons to offer valuable insights and foster intraoperative problem-solving abilities. However, it lacks consideration of individual patient factors and surgical nuances. Nevertheless, further refinement of its training data and rigorous scrutiny under experts to ensure the accuracy and up-to-date nature of the information holds the potential for it to be utilized in the surgical field.

Evaluating the Efficacy of Natural Language Processing Artificial Intelligence Models as a Patient Education Tool for Stature Lengthening Surgery and Reconstruction

Abstract Introduction: While traditionally a treatment for congenital deformities, limb-lengthening surgery has recently been utilized as a cosmetic solution for patients with less-than-desirable heights. Despite a growing rise in popularity, stature-lengthening surgery carries a host of social stigmas and ethical concerns. With the emergence of natural language processing artificial intelligence (NLP AI) models such as ChatGPT, patients interested in stature-lengthening surgery may turn to these chatbots for medical information instead of primary care providers. This study seeks to evaluate the quality and readability of NLP AI model responses to common questions regarding stature-lengthening surgery to ensure proper patient education and direction toward a licensed orthopedic surgeon. Materials and Methods: Eleven questions regarding limb-lengthening surgery were posed to ChatGPT version 3.5. All named authors reviewed the AI responses independently and utilized the following scoring systems to assess readability and quality: DISCERN, ChatGPT Response Accuracy Scoring (CRAS) developed by Mika et al., Flesch–Kincaid Reading Ease (FRES), and Flesch–Kincaid Grade Level (FKGL). Cohen’s kappa was utilized to determine the inter-rater reliability between each reviewer’s assigned DISCERN and CRAS scores. Results: The average DISCERN score across all independent reviewers was 55.2 ± 5.63, with an inter-rater reliability of 0.293, indicating good scores with fair agreement, respectively. The average CRAS score across all senior reviewers was 1.60 ± 0.63 with inter-rater reliability being 0.014, indicating none to slight agreement. The average FRES score was 14.8 ± 2.24, and the average FKGL score was 18.9 ± 11.0, indicating a required reading level of a college graduate. Conclusions: The results of our study show that NLP AI models provide generally high-quality responses to patient questions regarding stature-lengthening surgery. However, notable flaws were identified, including a high required education level for proper comprehension as well as an inability to cite source material used for each response.

Comparison of large language models in management advice for melanoma: Google's AI BARD, BingAI and ChatGPT.

Large language models (LLMs) are emerging artificial intelligence (AI) technology refining research and healthcare. Their use in medicine has seen numerous recent applications. One area where LLMs have shown particular promise is in the provision of medical information and guidance to practitioners. This study aims to assess three prominent LLMs-Google's AI BARD, BingAI and ChatGPT-4 in providing management advice for melanoma by comparing their responses to current clinical guidelines and existing literature. Five questions on melanoma pathology were prompted to three LLMs. A panel of three experienced Board-certified plastic surgeons evaluated the responses for reliability using reliability matrix (Flesch Reading Ease Score, the Flesch-Kincaid Grade Level and the Coleman-Liau Index), suitability (modified DISCERN score) and comparing them to existing guidelines. t-Test was performed to calculate differences in mean readability and reliability scores between LLMs and p value<0.05 was considered statistically significant. The mean readability scores across three LLMs were same. ChatGPT exhibited superiority with a Flesch Reading Ease Score of 35.42 (±21.02), Flesch-Kincaid Grade Level of 11.98 (±4.49) and Coleman-Liau Index of 12.00 (±5.10), however all of these were insignificant (p>0.05). Suitability-wise using DISCERN score, ChatGPT 58 (±6.44) significantly (p=0.04) outperformed BARD 36.2 (±34.06) and was insignificant to BingAI's 49.8 (±22.28). This study demonstrates that ChatGPT marginally outperforms BARD and BingAI in providing reliable, evidence-based clinical advice, but they still face limitations in depth and specificity. Future research should improve LLM performance by integrating specialized databases and expert knowledge to support patient-centred care.

Quality and readability of web-based information on dental caries in Arabic: an infodemiological study

BackgroundWeb-based information on dental caries in Arabic remains poorly understood. This study aimed to assess the quality and readability of web-based information about dental caries in Arabic.MethodsThe first 100 websites in Arabic about dental caries were retrieved from Google and Bing using common terms. The websites were classified and evaluated for quality based on the Journal of the American Medical Association (JAMA) benchmark criteria, the DISCERN tool, and the presence of the Health on the Net Foundation Code of Conduct (HONcode). Readability was assessed using online readability indexes.ResultsA total of 102 Arabic websites were included. The JAMA benchmark score was low (m = 0.36, SD = 0.56), with 67.7% failing to meet any of the JAMA criteria. The DISCERN total score mean was 37.68 (SD = 7.99), with a majority (67.65%) of moderate quality. None of the websites had the HONcode. Readability was generally good, with 52.94% of websites having a Flesch–Kincaid Grade Level (FKGL) < 7, 91.18% having a Simple Measure of Gobbledygook (SMOG) < 7, and 85.29% having a Flesch reading ease (FRE) score ≥ 80. There was a positive correlation between JAMA and DISCERN scores (p < 0.001). DISCERN scores were positively correlated with the number of words (p < 0.001) and sentences (p = 0.004) on the websites. However, JAMA or DISCERN scores were not correlated with FKGL, SMOG, or FRE scores (p > 0.05).ConclusionsThe quality of Arabic dental caries websites was found to be low, despite their readability. Efforts are needed to introduce more reliable sources for discussing dental caries and treatment options on sites aimed at Arabic populations.

When Checking a Box is not Enough: The (Un)Readability of PREA Messaging

The Prison Rape Elimination Act (PREA) was implemented to prevent sexual assault within correctional facilities. To communicate PREA principles to inmates, written materials including handbooks, policies, and brochures are utilized. This research evaluates the readability of PREA messaging, employing three established metrics: Flesh Reading Ease Score, Flesch–Kincaid Grade Level, and Simple Measure of Gobbledygook. Findings reveal significant deviation from recommended reading targets for both the general (7th–8th grade) and inmate (5th–6th grade) populations. Prison Rape Elimination Act policies averaged a 16th-grade level, raising concerns regarding the efficacy of PREA implementation and compliance in light of potential comprehension challenges.

Publisher Accreditation Fails to Reflect Higher Content Quality in Liver Transplant YouTube Videos

IntroductionIn 2021, the National Academy of Medicine began collaborating with YouTube to highlight high-quality channels for patients seeking medical information. This study evaluates whether YouTube videos from accredited publishers are useful for patients searching for information regarding liver transplantation. MethodsAfter searching “Liver Transplant” on YouTube, the first 100 results under 10 min long with English text or audio were transcribed. The Flesch–Kincaid grade level was used to quantify reading grade level. Viewership metrics and the accreditation status of the video publisher were identified. The DISCERN score was used to grade the quality of medical information. We adapted an informed consent curriculum for surgical interns to create an eight-point content metric that we coined the “Anderson-Lau score”. Higher scores indicated higher content quality. Statistical significance was calculated using Wilcoxon rank-sum and chi-squared tests with a significance level of P = 0.05. ResultsOf the 100 videos assessed, 37 met the average American reading level (8th grade) and none met the reading level of the average Medicare patient (5th grade). The median Flesch–Kincaid grade level was 9th grade. The median content (“Anderson-Lau”) and quality (DISCERN) scores were 2/8 and 1/5, respectively. While 56% of videos mentioned operative indications and benefits, under 25% mentioned operative steps, risks, alternatives, and postoperative expectations. A total of 75 videos were from accredited publishers, and there was no significant difference between the quality of videos from accredited and unaccredited publishers. ConclusionsVideos made by accredited sources regarding liver transplantation were not of higher educational quality or content. More informative educational materials are needed to advise patients about liver transplantation, help them understand the procedure, and to supplement discussions with their transplant team.

How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ± 2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ± 2.2 and 9.7 ± 2.1 sequentially. The mean Coleman-Liau index score was 10.0 ± 1.5, and the average Fry Readability score was 9.9 ± 2.0. The automated readability index for all websites was 10.3 ± 2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ± 10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.

Evaluation of Reading Level of Result Letters Sent to Patients from an Academic Primary Care Practice.

In primary care, low health literacy, particularly reading ability, is associated with worse health outcomes. Most physicians do not receive feedback on the reading levels of written communication that they may provide to patients, including result letters. Our study compares the readability of result letters, written by resident versus attending physicians, to patients with positive or negative screens for reading ability, as determined by the single-item literacy screener (SILS). Result letters to 50 patients at high risk and 50 patients at low risk of low reading ability were randomly selected starting from January 1st, 2020 at Albany Medical Center. Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) were used to compare the readability of resident versus attending result letters. For all SILS levels, attending physicians wrote result letters at a lower grade level than resident physicians based on the FKGL, GFI, and SMOG indices. The FKGL, GFI, and SMOG readability scores of result letters written to patients with SILS 3-5 were also lower when written by attending physicians compared to resident physicians. Result letters written by attending physicians may be easier to read than result letters written by resident physicians, especially for patients with low reading ability. Future electronic health record (EHR) software should give physicians and providers feedback on the reading level of their written communication.

“My knee is cracking” – What information is available on the internet about it? A systematic appraisal of the credibility, readability and accuracy of online information about knee crepitus

ObjectivesTo summarise and systematically appraise the credibility, readability, and accuracy of the online information about knee crepitus. DesignSystematic appraisal of online information. MethodThe top 20 URLs of two search engines (Google and Bing) for the following terms were screened for eligibility ‘knee crepitus’, ‘knee sound’, and ‘knee crackling’ (N ​= ​120 websites). Two reviewers assessed the websites for credibility (JAMA benchmark) and readability (Flesch Reading Ease and Flesch-Kincaid Grade Level tests). For accuracy, we performed a qualitative analysis creating thematic units based on the website's content and explored whether they were supported by evidence. ResultsFifty-one websites were included. There was a large variation in the overall credibility of websites, with more than half of the websites lacking credible information. The median Flesch reading ease was 62 (range ​= ​42–88) and Flesch–Kincaid grade level was 8 (range ​= ​3–12). Six key thematic units emerged from our qualitative analysis all with sub-themes within them. The main topics covered by websites were: (i) What is knee crepitus? (ii) Is knee crepitus a problem? (iii) What is the cause of knee crepitus? (iv) How to manage knee crepitus? (v) What are the health consequences of having knee crepitus? (vi) Who should I seek if I have knee crepitus? ConclusionPatients and clinicians should take caution when seeking web-based information about knee crepitus. Websites about knee crepitus lack credibility, present a large variation in readability outcomes, and there was no research evidence available to support most of their information.

Credibility, Accuracy, and Comprehensiveness of Readily Available Internet-Based Information on Treatment and Management of Peripheral Artery Disease and Intermittent Claudication: Review.

Peripheral artery disease (PAD) affects millions of people worldwide, and a core component of management of the condition is self-management. The internet is an important source of health information for many people. However, the content of websites regarding treatment recommendations for PAD has not been fully evaluated. This study aimed to assess the credibility, accuracy, and comprehensiveness of websites found via a common search engine, by comparing the content to current guidelines for treatment and management of PAD and intermittent claudication (IC). A review of websites from hospitals, universities, governments, consumer organizations, and professional associations in the United States and the United Kingdom was conducted. Website recommendations for the treatment of PAD and IC were coded in accordance with the guidelines of the National Institute for Health and Care Excellence (NICE) and the American Heart Association (AHA). Primary outcomes were website credibility (4-item Journal of the American Medical Association benchmark), website accuracy (in terms of the percentage of accurate recommendations), and comprehensiveness of website recommendations (in terms of the percentage of guideline recommendations that were appropriately covered). Secondary outcomes were readability (Flesch-Kincaid grade level) and website quality (Health On the Net Foundation's code of conduct). After screening, 62 websites were included in this analysis. Only 45% (28/62) of websites met the credibility requirement by stating they were updated after the NICE guidelines were published. Declaration of authorship and funding and the presence of reference lists were less commonly reported. Regarding accuracy, 81% (556/685) of website recommendations were deemed accurate on following NICE's and the AHA's recommendations. Comprehensiveness was low, with an average of 40% (25/62) of guideline treatment recommendations being appropriately covered by websites. In most cases, readability scores revealed that the websites were too complex for web-based consumer health information. Web-based information from reputable sources about the treatment and management of PAD and IC are generally accurate but have low comprehensiveness, credibility, and readability.

Evaluating the readability, quality and reliability of online patient education materials on post-covid pain.

BackgroundThe use of the Internet to access healthcare-related information is increasing day by day. However, there are concerns regarding the reliability and comprehensibility of this information. This study aimed to investigate the readability, reliability, and quality of Internet-based patient educational materials (PEM) related to “post-COVID-19 pain.”MethodsOne-hundred websites that fit the purposes of the study were identified by searching for the terms “post-COVID-19 pain” and “pain after COVID-19” using the Google search engine on February 24, 2022. The website readability was assessed using the Flesch Reading Ease Score (FRES), Flesch–Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning FOG (GFOG). The reliability, quality, and popularity of the websites were assessed using the JAMA score, DISCERN score/Health on the Net Foundation code of conduct, and Alexa, respectively.ResultsUpon investigation of the textual contents, the mean FRES was 51.40 ± 10.65 (difficult), the mean FKGL and SMOG were 10.93 ± 2.17 and 9.83 ± 1.66 years, respectively, and the mean GFOG was 13.14 ± 2.16 (very difficult). Furthermore, 24.5% of the websites were highly reliable according to JAMA scores, 8% were of high quality according to GQS values, and 10% were HONcode-compliant. There was a statistically significant difference between the website types and reliability (p = 0.003) and quality scores (p = 0.002).ConclusionThe readability level of PEM on post-COVID-19 pain was considerably higher than grade 6 educational level, as recommended by the National Institutes of Health, and had low reliability and poor quality. We suggest that Internet-based PEM should have a certain degree of readability that is in accordance with the educational level of the general public and feature reliable content.

Risk management committees and readability of risk management disclosure

This paper examines whether the presence of risk management committees is associated with the readability of risk management disclosure. Specifically, we consider the presence and the effectiveness of risk management committees. We measure the readability of risk management disclosure using six different readability indices, namely: Bog index; Flesch Reading Ease score; Coleman–Liau index; Flesch–Kincaid Grade level; Simple Measure of Gobbledygook; and Automated Reading index. We find that the presence and the effectiveness of risk management committees are associated with the higher readability of risk management disclosure. We adopt various methods, including an instrumental variable approach, the entropy balancing method and the dynamic generalised method of moments, to address endogeneity concerns. Taken together, our results highlight the important role of the risk management committee in communicating risk management information.