Net Code Research Articles

Assessment of Online Arabic Patient-Centered Knowledge About Orthognathic Surgery: An Infodemiologic Study.

Orthognathic surgery, addressing skeletal and dental irregularities, is pivotal for patients suffering from malocclusion, facial asymmetry, and related disorders. With the internet becoming a primary source of health information, the accuracy, quality, and reliability of online Arabic-language patient-centered information on orthognathic surgery necessitate thorough evaluation. This study aimed to assess the quality, reliability, and readability of Arabic online resources about orthognathic surgery to ascertain their potential as reliable patient education tools. An infodemiological approach was employed, analyzing the top 100 websites from Google, Yahoo, and Bing based on specific Arabic search terms related to orthognathic surgery. Websites were evaluated for affiliation, content specialization, and presentation and excluded based on predetermined criteria to ensure relevance and focus. Quality assessment was conducted using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health On the Net code evaluation. Readability was assessed using the Flesch-Kincaid Grade Level, Simplified Measure of Gobbledygook, and Flesch Reading Ease scales. Of 600 initial websites, 96 met the inclusion criteria. Most were affiliated with universities or medical centers (53.1%), followed by commercial (28.1%), and non-profit organizations (16.7%). The majority of websites (96.9%) were only partially related to orthognathic surgery. Content analysis revealed a moderate quality of information, with a median overall DISCERN quality rating of 3 out of 5. The JAMA benchmarks showed a lack of comprehensive adherence, with currency being the most achieved criterion. Readability assessments indicated the content was generally accessible yet highlighted the need for Arabic-specific readability evaluation tools. The study reveals a critical need for enhancing Arabic online resources on orthognathic surgery. Despite the available content's moderate quality and acceptable readability, there is a substantial gap in providing comprehensive, patient-centered, and easily understandable information. Future efforts should focus on developing high-quality, reliable, and readable online resources to aid Arabic-speaking patients in making informed decisions about orthognathic surgery.

Quality and Readability of Noise-Induced Hearing Loss Prevention-Related Websites.

This cross-sectional website analysis aimed to determine the readability and quality of English and Spanish websites pertaining to the prevention of noise-induced hearing loss. Cross-sectional website analysis. Various online search engines. We queried four popular search engines using the term "noise-induced hearing loss prevention" to reveal the top 50 English and top 50 Spanish websites for data collection. Websites meeting inclusion criteria were stratified based on the presence of a Health on the Net Code certificate (independent assessment of honesty, reliability, and quality). Websites were then independently reviewed by experts using the DISCERN criteria in order to assess information quality. Readability was calculated using the Flesch reading ease score for English and the Fernandez-Huerta formula for Spanish websites. Thirty-six English websites and 32 Spanish websites met the inclusion criteria. English websites had significantly lower readability (average = 56.34, SD = 11.17) compared to Spanish websites (average = 61.88, SD = 5.33) (P < .05). Spanish websites (average = 37, SD = 8.47) were also of significantly higher quality than English websites (average = 25.13, SD = 10.11). This study emphasizes the importance of providing quality and readable materials to patients seeking information about noise-induced hearing loss prevention. All of the English and Spanish websites reviewed were written at a level higher than the American Medical Association-recommended sixth-grade reading level. The study also highlights the need for evidence-based information online provided by experts in our field.

Evaluating the quality and reliability of YouTube videos on myopia: a video content analysis.

To evaluate the quality and reliability of YouTube videos as an educational resource about myopia. The videos were identified by searching YouTube with the keywords 'myopia' and 'nearsightedness', using the website's default search settings. The number of views, likes, dislikes, view ratio, source of the upload, country of origin, video type, and described treatment techniques were assessed. Each video was evaluated using the DISCERN, Journal of the American Medical Association (JAMA), Ensuring Quality Information for Patients (EQIP), Health On the Net Code of Conduct Certification (HONcode), and the Global Quality Score (GQS) scales. A total of 112 videos were included. The classification of videos by source indicated that the top three contributors were health channels (30 videos [26.8%]), physicians (24 videos [21.4%]), and academic centers (19 videos [16.9%]). Most of these videos originated from the United States (74 videos [66.1%]) and focused on the pathophysiology (n = 89, 79.4%) and the treatment (n = 77, 68.7%) of myopia. Statistical comparisons among the groups of video sources showed no significant difference in the mean DISCERN score (p = 0.102). However, significant differences were noted in the JAMA (p = 0.011), GQS (p = 0.009), HONcode (p = 0.011), and EQIP (p = 0.002) scores. This study underscored the variability in the quality and reliability of YouTube videos related to myopia, with most content ranging from 'weak to moderate' quality based on the DISCERN and GQS scales, yet appearing to be 'excellent' according to the HONcode and EQIP scales. Videos uploaded by physicians generally exhibited higher standards, highlighting the importance of expert involvement in online health information dissemination. Given the potential risks of accessing incorrect medical data that can affect the decision-making processes of patients, caution should be exercised when using online content as a source of information.

Quality, Reliability, Readability, and Accountability of Online Information on Leukocoria.

To evaluate the quality, reliability, and readability of online patient educational materials on leukocoria. In this cross-sectional study, the Google search engine was searched for the terms "leukocoria" and "white pupil." The first 50 search outcomes were evaluated for each search term based on predefined inclusion criteria, excluding duplicates, peer-reviewed papers, forum posts, paywalled content, and multimedia links. Sources were categorized as "institutional" or "private." Three independent raters assessed each website for quality and reliability using DISCERN, Health on the Net Code of Conduct (HONcode), and JAMA criteria. Readability was evaluated using seven formulas: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), Linsear Write (LW), Gunning Fog Index (GFI), and Coleman-Liau Index (CLI). A total of 51 websites were included. Quality, assessed by the DISCERN tool, showed a median score of 4, denoting moderate to high quality, with no significant differences between institutional and private sites or search terms. HONcode scores indicated variable reliability and trustworthiness (median: 10, range: 3 to 16), with institutional sites excelling in financial disclosure and ad differentiation. Additionally, institutional and private sites performed well in reliability and accountability, as measured by the JAMA Benchmark criteria (median: 3; range: 1 to 4). Readability, averaging an 11.3 ± 3.7 grade level, did not differ significantly between site types or search terms, consistently falling short of the recommended sixth-grade level for patient educational materials. The patient educational materials on leukocoria demonstrated moderate to high quality, commendable reliability, and accountability. However, the readability scores were above the recommended level for the layperson. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Assessment of the Arabic patient-centered online information about orthodontic pain: A quality and readability assessment.

This study assesses the quality and readability of Arabic online information about orthodontic pain. With the increasing reliance on the internet for health information, especially among Arabic speakers, it's critical to ensure the accuracy and comprehensiveness of available content. Our methodology involved a systematic search using the Arabic term for (Orthodontic Pain) in Google, Bing, and Yahoo. This search yielded 193,856 results, from which 74 websites were selected based on predefined criteria, excluding duplicates, scientific papers, and non-Arabic content. For quality assessment, we used the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net (HON) code. Readability was evaluated using the Simplified Measure of Gobbledygook (SMOG), Flesch Reading Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL) scores. Results indicated that none of the websites received the HONcode seal. The DISCERN assessment showed median total scores of 14.96 (± 5.65), with low overall quality ratings. In JAMA benchmarks, currency was the most achieved aspect, observed in 45 websites (60.81%), but none met all four criteria simultaneously. Readability scores suggested that the content was generally understandable, with a median FKGL score of 6.98 and a median SMOG score of 3.98, indicating middle school-level readability. This study reveals a significant gap in the quality of Arabic online resources on orthodontic pain, highlighting the need for improved standards and reliability. Most websites failed to meet established quality criteria, underscoring the necessity for more accurate and trustworthy health information for Arabic-speaking patients.

Quality, Reliability, and Readability of Online Information on Idiopathic Intracranial Hypertension.

To evaluate the quality & reliability, technical quality, and readability of patient-targeted online information on idiopathic intracranial hypertension. In this cross-sectional study, we searched Google and Bing search engines for the terms "idiopathic intracranial hypertension" and "pseudotumor cerebri." We evaluated the first 50 search outcomes for each search term. Peer-reviewed articles, targeted advertisements, book chapters, videos, personal blogs, websites intended for healthcare professionals, and non-English websites were excluded. Websites were classified as institutional or private. Two independent reviewers assessed each website for 1) quality and reliability using DISCERN, Health on the Net Code of Conduct (HONcode), and JAMA criteria and 2) technical quality based on 11 criteria. Readability was evaluated using 6 measures (Flesch-Kincaid Reading Ease score and grade level, Gunning Fog, Simple Measure of Gobbledygook (Smog) index, Coleman-Liau index, and automated readability index). Sixty-three websites (37 institutional) were included. The mean scores for the DISCERN, HONcode, and JAMA criteria were 3.6 ± 1 (1-4.8; 1: worse, 5: best), 10.3 ± 2.8 (2-16; 0: worse, 16: best), and 2 ± 1.3 (0-4; 0: worse, 4: best), respectively. The mean technical quality score was 0.8 ± 0.1 (0.5-1). The mean Flesch-Kincaid grade level score was 8.9 ± 1.8 (3.3-13.3). For Flesch-Kincaid grade level, 47 (74.6%) websites scored a grade level of 10 or less. For Gunning Fog Score, 35 websites (55.6%) scored from 7.3 to 10.8. For the Smog Index, 46 (73%) websites scored 5.7-8. The mean Coleman Liau Index was 16 ± 2.1 (9.6-22.2). For the automated readability index, 30 (50.7%) websites scored less than the eighth grade. No statistically significant difference was present between institutional and private websites except for JAMA, which scored higher in private websites (2.4 vs 1.7, P = 0.03). Our findings suggest that online information on idiopathic intracranial hypertension/pseudotumor cerebri for patients generally demonstrates moderate to good quality and reliability. Although most websites maintain credible technical quality, the readability exceeds recommended levels for the average American reader. This may impede understanding, emphasizing the need for future improvements.

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.

Phototherapy for vitiligo: Quality and readability of online health information.

Vitiligo is a depigmenting disorder that affects up to 2% of the population. Due to the relatively high prevalence of this disease and its psychological impact on patients, decisions concerning treatment can be difficult. As patients increasingly seek health information online, the caliber of online health information (OHI) becomes crucial in patients' decisions regarding their care. We aimed to assess the quality and readability of OHI regarding phototherapy in the management of vitiligo. Similar to previously published studies assessing OHI, we used 5 medical search terms as a proxy for online searches made by patients. Results for each search term were assessed using an enhanced DISCERN analysis, Health On the Net code of conduct (HONcode) accreditation guidelines, and several readability indices. The DISCERN analysis is a validated questionnaire used to assess the quality of OHI, while HONcode accreditation is a marker of site reliability. Of the 500 websites evaluated, 174 were HONcode-accredited (35%). Mean DISCERN scores for all websites were 58.9% and 51.7% for website reliability and treatment sections, respectively. Additionally, 0/130 websites analyzed for readability scored at the NIH-recommended sixth-grade reading level. These analyses shed light on the shortcomings of OHI regarding phototherapy treatment for vitiligo, which could exacerbate disparities for patients who are already at higher risk of worse health outcomes.

Assessing the scientific quality and reliability of YouTube videos about chemotherapy.

No studies have evaluated the interaction, quality, and reliability of chemotherapy-related videos published on YouTube. The aim was to evaluate the content of YouTube videos about chemotherapy using 5 different scoring tools. In this cross-sectional register-based study, popular videos on YouTube about the following keywords were examined; "chemotherapy," "what is chemotherapy," "types of chemotherapy," "chemotherapy side effects" and "chemotherapy treatments." Quality and reliability of video content were measured using the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA), the Global Quality Score (GQS), the Video Information Quality Index (VIQI), and Health on the Net code (HONcode) scores. A total of 108 videos were analyzed in the study. The median duration was 200 (30-2020) seconds and the median total number of views was 17500 (61-8615000). Among the video publishers, private hospitals were the most (n = 36, 33%). The most (n = 71, 66%) populer category of videos were patient education videos. Half (n = 55, 51%) of the narrators in the videos were only oncology professionals. Mean DISCERN, JAMA, GQS, VIQI, and HONcode scores were 2.73 ± 1.18, 1.97 ± 1.05, 2.94 ± 1.08, 14.03 ± 3.73, and 4.68 ± 2.46, respectively. A positive correlation was found between the 5 scoring points (P < .001 for all pairwise comparisons). There was a significant difference between video quality scores according to video categories and video publishers (P < .001 for both). Although most YouTube videos about chemotherapy were helpful to patients, content quality and reliability were moderate-low. Cancer patients looking for information on chemotherapy may find YouTube videos beneficial, but clinicians must be cautious to clear up any misunderstandings.

How readable and quality are online patient education materials about Helicobacter pylori?: Assessment of the readability, quality and reliability.

This study aimed to examine the readability, reliability, quality, and content of patient education materials (PEM) on the Internet about "Helicobacter pylori (H pylori)." A search was conducted on March 14, 2023, using the keyword "H pylori" in the Google search engine. The readability of PEMs was assessed using the Flesch reading ease score, FKGL, simple measure of gobbledygook, and gunning fog readability formulas. The reliability and quality of the websites were determined using the Journal of American Medical Association score, health on the net foundation code of conduct, global quality score, and DISCERN score. A total of 93 patient education websites were included in the study. In the readability analysis of PEMs, we determined that the Flesch reading ease score was 49,73 (47,46-52,00) (difficult), the mean Flesch-Kincaid grade level and simple measure of gobbledygook were 9,69 (9,26-10,12) and 9,28 (8,96-9,61) years, respectively, and the mean gunning fog score was 12,47 (12,03-12,91) (very difficult). Most of the evaluated patient educational materials were commercial websites (n = 50, 53.8%). It was found that 16.1% of the websites were of high quality according to global quality score, 30.1% were HON code certified, and 23.7% of the websites were highly reliable according to Journal of American Medical Association scores. There was no statistically significant difference between website typologies and readability (P > .05). However, there was a statistically significant difference between website typologies and quality and reliability scores (P < .005). Compared to the sixth grade level recommended by the American Medical Association and National Institutes of Health, the readability of H pylori-related internet-based PEMs is quite high. On the other hand, the reliability and quality of the PEMs were determined as moderate to poor. PEMs for issues threatening public health should be prepared with attention to recommendations on readability.

A&amp;F effectiveness in reducing avoidable health differences: Equity issues &amp; COVID 19

Abstract Background Healthcare equity aims to ensure that everyone can access affordable, culturally competent healthcare since everyone has a fair and just opportunity to attain their highest level of health. Italian National Health Service is characterized by the principles of universality and equality with the aim of the progressive overcoming of inequalities and social and territorial imbalances. The development of the principle of equality has made it possible to focus on three different areas in which the corollary of equity must find concrete implementation: access to health benefits and services, health outcomes for individual subjects, and the allocation of resources and services as needed. Key performance indicators (KPIs) are described as essential in studying and enhancing healthcare performance. Methods Within the network project EASY-NET (NET code 2016-02364191), we carried out an A&amp;F study in Friuli Venezia Giulia region, Italy, over 4 years, evaluating the equity of emergency healthcare access. We calculated 6 KPIs investigating gender, education, residence, and nationality using administrative health databases. We calculated and compared 2019, 2020, and 2021 KPIs. Results We observed a reduction in emergency care access during the pandemic, greater among women than among men, as reported in the literature, and an increase in access among citizens with ‘not detected/no qualification’ scholarship level and citizens with non-EU or not detected country of birth. Conclusions Consistently with the literature, since the beginning of the pandemic, the population turned less to emergency health services, above all women. On the other hand, and contextually no-level-of-schooling citizens and non-EU-birth citizens turned more compared to the rest of the population. While healthcare systems were focused on COVID-19, a worrying reduction in access to care was observed, bringing attention to the issue of healthcare equity both during and post COVID. Key messages • We observed a reduction of healthcare access in the emergency context, above all for women, since the pandemic began. • Non-EU-birth citizens and citizens with no level of schooling had more frequent access to emergency health services than the rest of the population in the pandemic context.

Are allergic conjunctivitis videos on YouTube a reliable source of information?

ABSTRACT Background Social media as well as YouTube are widely used to gain information on medical conditions. We aimed to assess and evaluate the quality and reliability of YouTube videos on ocular allergies and determine whether they are a trustworthy source of information. Research design and methods The first 60 videos from the search terms ‘allergic conjunctivitis’, ‘atopic conjunctivitis’, ‘allergic conjunctivitis symptoms’, and ‘allergic conjunctivitis eye drops’ were analyzed using modified DISCERN, Global Quality Score, Journal of the American Medical Association scores, and Health on the Net Code criteria. The total number of views, view ratio, likes, comments, and duration were recorded, and videos were evaluated as useful, non-useful, and misleading. Results The average mDISCERN score for the videos was 3.25 ± 0.76 (moderate), the average JAMA score was 2.76 ± 0.64 (intermediate), the average GQS score was 3.13 ± 0.8 (intermediate), and the average HONcode score was 7.8 ± 2.6 (intermediate). The most common video source was health professionals (61.9%). Conclusions Videos on allergic conjunctivitis while having reliable publishers are of moderate quality. Quality regulation of content uploaded on allergic conjunctivitis is needed. Health professionals should try to improve video content and provide more information on the treatment of allergic conjunctivitis.

Assessment of Arabic Web-Based Knowledge About Clear Aligners: An Infodemiologic Study.

Orthodontic treatments aim to enhance dental aesthetics, functionality, and long-term oral health. Clear aligners have gained popularity as an aesthetic and convenient option for patients seeking orthodontic correction. However, the quality and readability of online Arabic patient-centered information regarding clear aligners has not been studied yet. The aim of our study is to investigate the quality and readability of Arabic patient-centered information about clear aligners. We conducted an extensive evaluation of Arabic web-based content pertaining to clear aligners using three prominent search engines. Eligible websites were categorized based on specialization, organizational affiliation, material type, and presentation style. We assessed website quality and reliability using the DISCERN instrument, Journal of American Medical Association (JAMA)benchmarks, and Health on the Net (HON) code. In addition, we measured readability using the Flesch Reading Ease Score (FRES), Simplified Measure of Gobbledygook (SMOG), and Flesch-Kincaid Grade Level (FKGL). Out of 600 search results, 195 websites met the inclusion criteria. None of the websites were HON-code accredited. DISCERN assessments revealed low content quality, with none of the websites achieving high-quality status. The JAMA benchmarks showed limited compliance with the four items, with currency being the most frequently achieved. Readability assessments indicated generally high readability, with FKGL scores suggesting easy comprehension for the average readers. While Arabic web-based information on clear aligners is highly readable, its credibility and quality require significant improvement. Websites should adhere to medical information standards, subject content to rigorous assessments, and seek accreditation to ensure reliability. Enhancing the accessibility and comprehensibility of health-related content will empower individuals to make informed health decisions. Addressing limitations, such as social media and video content evaluation, and conducting comparisons with English websites in future research will provide a more comprehensive understanding of the landscape of online orthodontic information.

Online Patient Education Resources for Anterior Cruciate Ligament Reconstruction: An Assessment of the Accuracy and Reliability of Information on the Internet Over the Past Decade.

The purpose of this study is to evaluate the quality of patient education materials accessible through popular online search engines regarding anteriorcruciateligament (ACL) injuries and anteriorcruciateligament reconstruction (ACLR). Methods: Two search terms ("ACL surgery" and "ACL reconstruction") were entered into three search engines (Google, Yahoo, and Bing). The quality of information was scored using a novel scoring system developed and overseen by sports medicine orthopedic clinical research fellows and fellowship-trained orthopedic surgeons. Website quality, credibility, and readability were further assessed by the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria, and Flesch-Kincaid Reading Grade Level (FKRGL), respectively. The Health On the Net Code of Conduct (HONcode) certification was also utilized to assess the transparency of health information for each website. We evaluated 39 websites. The average score for all websites was 11.2±5.6 out of 28 total points. Six out of the 39 websites (41%) were HONcodecertified. The websites that contained HONcode certification had a higher average JAMA benchmark score (3.5±0.7) and DISCERN score (44.6±14.7) when compared to the websites without the certification, 2.2±1.2and 37.6 ± 15.9for JAMA and DISCERN, respectively. The mean JAMA benchmark score was 2.7±1.2 (67.5%) for all websites out of a possible four points. The average FKRGL for all 39 websites was 10.0±2.0 (range: 5.4-13). The quality of patient education materials accessible on the internet regarding ACL injuries and ACLR can be misleading and directly impact the patient's decision-making process essential to the patient-physician relationship over the past decade. The internet can be a helpful online resource, however, surgeon clarification and consultation with qualified healthcare professionals are strongly recommended prior to clinical decision-making regarding potential treatment options.

From quality to clarity: evaluating the effectiveness of online ınformation related to septic arthritis

BackgroundThe aim of this study was to assess the content, readability, and quality of online resources on septic arthritis, a crucial orthopedic condition necessitating immediate diagnosis and treatment to avert serious complications, with a particular focus on the relevance to individuals from the general public.MethodsTwo search terms (“septic arthritis” and “joint infection”) were input into three different search engines on the Internet (Google, Yahoo, and Bing) and 60 websites were evaluated, with the top 20 results in each search engine. The websites underwent categorization based on their type, and their content and quality were assessed utilizing the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark, the Global Quality Score (GQS), and the Information Value Score (IVS). The readability of the text was assessed through the utilization of the Flesch Kincaid Grade Level (FKGL) and the Flesch Reading Ease Score (FKRS). The presence or absence of the Health on Net (HON) code was evaluated on each website.ResultsThe DISCERN, JAMA, GQS, FKGL, and IVS scores of the academic category were found to be substantially greater when compared with the physician, medical, and commercial categories. But at the same time, academic sites had high readability scores. Websites with HON code had significantly higher average FKGL, FCRS, DISCERN, JAMA, GQS, and IVS scores than those without.ConclusionThe quality of websites giving information on septic arthritis was variable and not optimal. Although the content of the academic group was of higher quality, it could be difficult to understand. One of the key responsibilities of healthcare professionals should be to provide high quality and comprehensible information concerning joint infections on reputable academic platforms, thereby facilitating patients in attaining a fundamental level of health literacy.

Spontaneous coronary artery dissection (SCAD) websites: systematic appraisal of content, quality, readability and suitability of websites for SCAD survivors

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Solve CHD NHMRC Synergy Grant Background Spontaneous coronary artery dissection (SCAD) is estimated to account for 4% of acute coronary syndrome presentations but is a distinctly different disease and demographic from typical atherosclerotic heart attacks. Survivors of SCAD typically turn to the internet for information. However, websites are not subject to stringent quality regulation. Purpose This study identified and appraised websites containing SCAD information using a variation of a systematic review study design. Quality, suitability, readability and content accuracy and scope were assessed. Methods Keywords related to SCAD definition, rarity, treatment, support and life after SCAD were searched in Google. Results were screened and evaluated systematically. Information content was assessed using a point-scoring tool based on current SCAD consensus literature. Quality and suitability of the websites was assessed using the Suitability Assessment of Materials, Quality Component Scoring System (QCSS), the Health-Related Website Evaluation Form (HRWEF), and adherence to the Health on the Net code. Readability was assessed using the Simple Measure of Gobbledygook, Flesch-Kincaid, and a readability generator. Results Of the 600 screened, n=316 duplicates were removed and n=50 eligible websites were included. Websites were most frequently made by hospital groups (34%), independent organisations (20%) and survivors (24%). The most frequent grading of quality was poor (32%) or good (30%) using the QCSS and adequate using the HRWEF (74%). Suitability of materials was overall adequate (64%). Content, scope and depth across websites had a mean score of 47.5 (SD 25.0) and was rated poor. The websites with highest scores for factually accurate content were survivor made (57.9%) and national foundations (56.3%) versus professional associations (34.6%) and hospital groups (35.2%) which had the lowest. The emotional impact of SCAD was addressed in 52% and content regarding family or partners support was given in 40%. Survivors had input in 63% and survivor groups were recommended in 50%. Most websites were rated fairly difficult (46%) or difficult to read (42%), with a mean readability grade of 11.6 (SD 2.3). Conclusions Despite high availability and fair quality, websites for SCAD survivors to access have poor content depth and require higher reading proficiency to understand. Almost half neglect the emotional impact of SCAD on the survivor and their families. Given the generally poor content of information available online, it is essential that SCAD survivors are provided high quality information on discharge from hospital and during cardiac rehabilitation. Health authority website are considered authoritative sources and for SCAD need to be improved. Survivor and national foundation websites may be the most appropriate to recommend for SCAD information currently due to higher factually correct content scores, broader scope of information, and demographically contextual material.

Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy.

To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal. We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system). We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were "fairly difficult to read," suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible. The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.

(239) Readability Assessment of Online Educational Information on Premature Ejaculation

Abstract Introduction Approximately one-third of US adults have trouble reading and acting on health-related information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials should not exceed a sixth-grade reading level. Given the difficulty in defining premature ejaculation (PE) and the lack of a US Food and Drug Administration (FDA) - approved drug therapy, many patients may seek information about PE through online resources. We sought to assess the readability and quality of online educational information on PE in light of these standards. Objective To assess the quality and readability of available online educational information on premature ejaculation using a Google search. Methods The search term “premature ejaculation” was queried on Google and the first 100 web pages were assessed. Duplicate websites, scientific publications, sub-pages of identical websites, or websites with paywalls were excluded from the analysis. Readability was assessed by three validated indices: the Flesch-Kincaid grade level (FKG), the Simple Measure of Gobbledygook (SMOG), and the Coleman-Liau Index (CLI). The quality of websites was assessed using the DISCERN instrument and the presence of Health on the Net (HON) code certification. Results After applying the exclusion criteria, a total of 43 websites were included in the data analysis. There were 15/43 (36.6%) web pages with HON code certification. On average, patient education materials about PE were written at a grade level of 12.2 (range 8.1-17.9). The mean DISCERN score for all web pages was 48.9 out of 80, which is considered “fair” quality. Web pages with HON code certification had a higher mean DISCERN score of 51.7 versus 47.3, which was not found to be significantly different (P=0.19). Conclusions Most of the online educational information on PE is of mediocre quality. In addition, the average web page on PE is written at a senior high school level, exceeding the recommended readability standards set by the AMA and NIH. It is imperative to place an emphasis on improving the quality and readability of online health information on PE to optimize patients’ abilities to make informed decisions. Disclosure No

35 Burn Prevention in Spanish: Assessment of Content Accuracy, Website Quality, and Readability of Online Sources

Abstract Introduction Many burn injuries are preventable, yet burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Out of the estimated 480,000 people in the US that are treated annually for burns, 14% identify as Latinx. Among the 60 million Latinx individuals living in the US, 33% report limited English proficiency. As a result, many Latinx persons rely on health information in Spanish. The availability and quality of Spanish language information regarding burn prevention has not previously been studied but presents an important opportunity to reduce burn-related injuries for the US Latinx population. Our objective was to systematically analyze the content accuracy, website quality, and readability of Spanish language online information for burn prevention in the home. Methods We conducted a search on Google, Bing, and Yahoo using the following key burn prevention terms in Spanish: “prevención de quemaduras,” “prevenir quemaduras,” “evitar quemaduras,” and “impedir quemaduras”. The top 10 results from each search engine and key term were recorded. Using recommendations from national organizations and a burn care expert team, two reviewers independently evaluated the content accuracy of each website and met to reach consensus. We assessed website quality by three major categories based on the Health on the Net Code of Conduct (HONcode): accessibility/usability, credibility, and currency. We scored readability of each website by utilizing five validated readability tests for the Spanish language and generating an average grade reading level needed to understand the article. Results After removing duplicates and irrelevant search results, 23 websites in Spanish met inclusion criteria. Across all websites, the content accuracy of information broken down by type of burn was as follows: scald 35%, electrical 28%, contact 20%, and flame 17%. Out of 21 possible points, the top website scored 14 (66.7%) and the average score was 6.6 (31.4%). Using the intraclass correlation coefficients, the interrater reliability was 0.935. For website quality, the average score was 50.2%. The average grade level needed to read the websites was 8.6. Conclusions Spanish language online information on burn prevention in the home is often inaccurate and incomplete. Furthermore, overall website quality was lower than 50% according to the HONcode, and the average grade level needed to read the articles is higher than the sixth-grade recommendation from the American Medical Association. Applicability of Research to Practice This research highlights the lack of reliable and accessible information in Spanish on home burn prevention. Not only does this research suggest that Spanish-speaking patients should be provided education on burn prevention by their healthcare providers, but more importantly, we propose a call to action to increase the quality of online Spanish materials for burn prevention for the US Latinx community.

What Our Patients and Their Families Are Reading: Quality and Readability of Internet Information About Electroconvulsive Therapy.

The Internet is now more widely used than before by psychiatric patients and their families to search for medical conditions and treatments. To our knowledge, no study has addressed the quality and readability of online information about electroconvulsive therapy (ECT). We aimed to examine the quality and readability of English-language Internet information related to ECT. An advanced search of Internet Web sites containing information about ECT was conducted by using the search term "ECT or electroconvulsive therapy." The resulting Web sites were categorized into 1 of 3 categories (commercial, nonprofit, or professional organizations). Their quality was evaluated using Health on the Net code certification, the Journal of the American Medical Association (JAMA) benchmark criteria, and the DISCERN tool. The readability of the Web sites was assessed using the Flesch Reading Ease, Flesch-Kincaid Grade Level Formula, Simple Measure of Gobbledygook, and Gunning Fog indexes. A total of 86 Web sites were included in the analysis. Of all these Web sites, 18 (20.9%) had a Health on the Net code certificate, and 16 (18.6%) were accepted as high quality (JAMA total score ≥3). The commercial Web sites had significantly lower DISCERN and JAMA benchmark scores compared with the other Web sites. A total of 30.23% of all the Web sites reached the recommended readability level (Flesch-Kincaid Grade Level Formula ≤ 8). Moreover, only 4 scored at the grade 5 to 6 reading level, which is considered ideal for patient educational materials. Our study indicates that both the quality and readability of online information about ECT are not at the desired level. Physicians, patients, and their families should consider this failure in relation to online information about ECT. In addition, Web site creators and health authorities should be aware of their responsibilities for providing quality and readable health information to the public.