Net Code Research Articles

The quality, understandability, readability, and popularity of online educational materials for heart murmur.

Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur. An Internet search was performed for "heart murmur" using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains' popularity and visibility. We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were "easy to understand". The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch-Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9). We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.

Social media and critical care

Social media has transformed the way we communicate with each other in the last decade or so. Out of 4 billion internet users, more than 3 billion are on social media. The medical community has also been transformed in terms of how we approach this vast medium of information. Microblogging sites like Twitter are beneficial in the way we share and disseminate professional knowledge. The critical care community has recently gained a lot of pace on the social media platform and are showing their presence in numbers.1 Although use of social media in critical care has great potential to benefit its users, it comes with its own challenges. This includes inaccurate information and slow adaptation. So the question arises: How can the critical care community make the best use of social media resources while ensuring the right knowledge is shared and practiced, and patient confidentiality is always respected?Twitter has been used as a medium to not only spread information but also as a platform to teach critical care physicians and nurses. There are elements which affect the usability, efficiency, effectiveness, and widespread acceptance of Twitter as a teaching aid.2 FOAM, free open access medical education, is an online movement taking place across social media, blogs, and podcasts that is challenging traditional methods of medical education.3 FOAM provides a free platform for learners to not only receive information but also share it with other users. It gives the learner a chance to tailor their resources according to their individual needs. In addition, learners can reach out for assistance from the source much more easily as compared to traditional ways. But concern has been raised on how to best approach these resources as they do not undergo vigorous checks like peer reviewed articles. Check and balance of the validity of the provided information is often left up to the learners discretion. It can leave educational gaps at times and may not be applicable worldwide. Similarly, declaration of conflict of interest is not mandatory on these platforms hence it is often impossible to identify commercial bias.It can be quite difficult to keep track of all the continuing professional development hours spent on social media but new applications are being developed, which can help. While on social media, all the norms and etiquette of healthcare professionalism should be maintained such as patient confidentiality and appropriate interprofessional relationships. There are evolving tools to evaluate the quality of various resources like SMi (Social Media Index)4 and HONcode (Health on the Net Code of Conduct).5Social media, when used correctly, can be effective for self-directed learning, holding discussions with other critical care and healthcare professionals while reflecting on newly-acquired knowledge. Although the information must be used with due care, as the peer review is mostly inexistent in social media as people can post what they want, it is one of the most exciting and evolving areas in critical care practice.

How Do Publicly Available Allergy-Specific Web-Based Training Programs Conform to the Established Criteria for the Reporting, Methods, and Content of Evidence-Based (Digital) Health Information and Education: Thematic Content Evaluation.

BackgroundAllergic diseases, such as allergic asthma, rhinitis, and atopic eczema, are widespread, and they are a considerable burden on the health care system. For patients and health care professionals, Web-based training programs may be helpful to foster self-management and provide allergy-specific information, given, for instance, their good accessibility.ObjectiveThis study aimed to assess an exploratory sample of publicly available allergy-specific Web-based training programs—that is, interactive, feedback-oriented Web-based training platforms promoting health behavior change and improvement of personal skills—with regard to (1) general characteristics, aims, and target groups and (2) the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information and education.MethodsWeb-based training programs were identified via an initial Google search and a search of English and German language websites of medical and public health services, such as the European Centre for Allergy Research Foundation (German), Asthma UK, and Anaphylaxis Canada. We developed a checklist from (1) established guidelines for Web-based health information (eg, the Journal of the American Medical Association benchmarks, DISCERN criteria, and Health On the Net code) and (2) a database search of related studies. The checklist contained 44 items covering 11 domains in 3 areas: (1) content (completeness, transparency, and evidence), (2) structure (data safety and qualification of trainers and authors), and (3) impact (effectiveness, user perspective, and integration into health care). We rated the Web-based training programs as completely, partly, or not satisfying each checklist item and calculated overall and domain-specific scores for each Web-based training program using SPSS 23.0 (SPSS Inc).ResultsThe 15 identified Web-based training programs covered an average of 37% of the items (score 33 out of 88). A total of 7 Web-based training programs covered more than 40% (35/88; maximum: 49%; 43/88). A total of 5 covered 30% (26/88) to 40% (35/88) of all rated items and the rest covered fewer (n=3; lowest score 24%; 21/88). Items relating to intervention (58%; 10/18), content (49%; 9/18), and data safety (60%; 1/2) were more often considered, as opposed to user safety (10%; 0.4/4), qualification of staff (10%; 0.8/8), effectiveness (16%; 0.4/2), and user perspective (45%; 5/12). In addition, in 13 of 15 Web-based training programs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% of all Web-based training programs (7/15) scored on use of scientific research, 53% on regular information update (8/15), and 33% on provision of references (5/15). None of 15 provided details on the quality of references or the strength of evidence.ConclusionsEnglish and German language allergy-specific Web-based training programs, addressing lay audiences and health care professionals, conform only partly to established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Particularly, well-conducted studies on their effectiveness are missing.

Does Google™ Have the Answers? The Internet-based Information on Pelvic and Acetabular Fractures.

IntroductionThe aim of this study is to assess the readability and reliability of internet-based information on pelvic and acetabular fractures.MethodsThe three most popular English-based internet search engines are Google, Yahoo, and Bing. Quality was assessed using the DISCERN tool, the Journal of the American Medical Association tool, and the presence of the Health on the Net Code (HONcode) seal. Readability was assessed using a combination of the Flesch Reading Ease Score and the Flesch-Kincaid grade level. Inclusion criteria included English language websites with the relevant search terms. We excluded videos, YouTube links, or sponsored advertisements. Search terms included acetabular fracture/fractured acetabulum and pelvic fracture/fractured pelvis. The top 25 websites in each search engine were reviewed. The searches for acetabular fractures and pelvic fractures generated 75 websites in total. Duplicates were excluded.ResultsThe search for acetabular fracture revealed 36 discrete websites among the three search engines, and the search for pelvic fractures revealed 45 websites. Overall, the average reading grade was 9.7 for acetabular websites and 13.6 for pelvis websites. The quality of the websites was poor across all key performance indicators studied.ConclusionPhysicians should be aware of the quality of medical information available to patients via internet searches because physicians should play a central role in the navigation of poor quality information to help direct patient-centered care.

Male infertility websites: what are our patients reading?

People ages 20-45 years (reproductive age) have been shown to use the Internet as a source of health information more frequently than their older counterparts. We sought to evaluate the quality and readability of highly visible websites on male infertility. Structured website review. Using Google, the first 60 relevant websites from the search “male infertility” were classified by source and analyzed. Content was evaluated by 4 blinded reviewers. We chose Google because it is the most widely used search engine, comprising 74.5% of Internet searches. Website quality of information was evaluated using the DISCERN score (assesses the quality of written information on treatment choices for a health problem), JAMA benchmark criteria (uses four core standards to evaluate web sites: authorship, attribution, disclosure, currency), and Health on the Net code (HONcode) accreditation status (assesses the reliability and credibility of online information). Readability was assessed using the Dale-Chall and Flesh Reading Ease indexes. Websites were classified as: 43% hospital based, 12% fertility clinic based, 5% other clinic based, 33% society/association based, and 7% government based. The mean total DISCERN score was 44 ± 12 (maximum score 80). 75% (45/60) of websites had clear aims or achieved their aims (scores of 4 or 5 [good]), but only 15% (9/60) described areas of clinical uncertainty. 25% (15/60) described the benefits of treatments, but only 5% (3/60) described the risks of treatments. 72% (43/60) provided unbiased information. 68% (41/60) websites made it clear that there was more than one possible treatment choice. 27% (16/60) of websites encouraged shared decision making. Overall, 60% (36/60) of websites were “poor quality” (score 1-2-3) on the final question of the DISCERN instrument. Only 4/60 (6.7%) websites met all four JAMA benchmark criteria. The mean Dale-Chall score was 9.53 +/- 1.30, indicating a college or graduate degree level of readability. The mean Flesh Reading Ease index was 34.01 +/- 16.26, indicating a graduate degree level of readability. 20% (12/60) of websites were HONcode certified. Websites on “male infertility” are of low quality, and only 6.7% met JAMA benchmark criteria. Minimal information on treatments was present, with only 25% of websites describing treatment benefits, but only 5% describing treatment risks. Only 15% of websites described areas of clinical uncertainty. Despite that these websites were written at a college to graduate degree level of reading, only 27% encouraged shared decision making. Reassuringly, most of these websites were hospital based, and 72% provided unbiased information. Patients should be cautioned that incomplete and potentially biased information on male infertility is prevalent online.

Comprehensiveness, readability, and reliability of Brazilian websites available for lay people’s guidance on adenotonsillectomy

IntroductionAdenotonsillectomy is an invasive surgical procedure, which may encourage the search for information by the lay population through online search engines. The quality of this information, however, requires an evaluation due to the wide diversity of the available content. ObjectiveTo evaluate the quality, in terms of ethical principles, readability and comprehensiveness, of the most accessed websites concerning guidance to parents/guardians related to their children’s recommended adenotonsillectomy. MethodsThe websites mentioned on the first 10 pages obtained after the search using “removal”, “tonsils” and “adenoids” as keywords, after applying the inclusion and exclusion criteria, were selected. All were assessed using the Flesch Readability Index and Health on the Net Code tools, in addition to an evaluation of the content by two independent evaluators. The data were described, and the inter-rater agreement was calculated by the Kappa coefficient. Results34 websites were found, of the 100 assessed ones, which met the inclusion and exclusion criteria using the Google and Yahoo! Tools. Sixteen (47%) pages were considered reasonably difficult/difficult to read according to the Flesch Readability Index. Most of them met less than half of the analyzed ethical requirements according to the Health on the Net Code, and the overall comprehensiveness average was considered insufficient. ConclusionA deficit of overall quality (comprehensiveness, readability, and ethical principles) was demonstrated for the websites available to parents or guardians about the adenotonsillectomy procedure in children.

Quality, readability, and understandability of internet-based information on cataract

Cataracts are the leading cause of blindness worldwide. The Internet is a major source of health information for patients and their families. Here, we determine the quality, content, and readability of health information related to cataracts on the Internet. The quality, content, readability, and popularity of health information on cataracts were assessed using different validated questionnaires and tools. The search term “cataract” was used in the three most common search engines on the Internet Google.com (Mountain View, CA), Bing.com (Redmond, WA), and Yahoo.com (Sunnyvale, CA). We initially included 30 websites from each search engine. After excluding duplicate and unrelated websites, 24 websites were included in the final analyses. Quality of health information was assessed using three validated instruments: the DISCERN questionnaire, the JAMA Benchmark criteria, and the Health On Net code. Content was evaluated via a checklist extrapolated from different resources to cover critical elements related to cataracts. Readability was assessed using three different readability scores. The average DISCERN score for all websites was 46 out of 80, and the JAMA Benchmark criteria were suboptimal with an average score of 1.125 out of 4. The majority of the websites (20; 83.3%) possessed a Health On Net certificate. Readability was challenging; the average grade level was suitable for secondary grades and beyond. The quality of health information on cataracts is widely variable but weak overall. A standardized method for writing and revising cataract health information on the Internet should be adopted.

Assessment of the quality and readability of online information on autopsy for the general public: a cross-sectional analysis

ObjectivesHospital (consented) autopsy rates have dropped precipitously in recent decades. Online medical information is now a common resource used by the general public. Given clinician reluctance to request hospital postmortem...

Evaluating the Quality, Content, and Readability of Online Resources for Failed Back Spinal Surgery.

An Internet-based assessment of websites using recognized score systems. To assess the quality, content, and readability of online information for failed back spinal surgery (FBSS). A significant amount of patients still suffer from chronic or recurrent back pain with or without radicular symptoms after spinal surgery. More and more patients use the Internet to find health-related information. Low-quality or inaccurate information may not only misleading patients but also have a negative impact on the trust between patients and physicians. The terms "chronic pain after spinal surgery," "chronic pain after back surgery," "failed back surgery syndrome," "post spinal surgery syndrome," and "post laminectomy syndrome" were entered into three search engines (Google, Yahoo!, and Bing). The first 25 websites from each search were reviewed. The quality, content, and readability of each website were evaluated using DISCERN score, FBSS-specific content score, and the Journal of the American Medical Association (JAMA) benchmark criteria, the first two score systems were assessed by three reviewers independently. The Flesch-Kincaid grade level (FKGL) was used to assess the readability. Each website with or without the Health on the Net Code (HONcode) was also recorded. Seventy-two websites were analyzed in our study. The average DISCERN score for all websites was 35.26 ± 11.45, indicating the quality of the websites was poor. The DISCERN score of physician websites was 31.25 ± 9.08, lower than that of media (36.50 ± 0.71, P = 0.017) and commercial websites (42.55 ± 10.93, P = 0.045). The mean FBSS-specific content score was 9.58 ± 3.90 out of maximum 25. We failed to find any difference of FBSS-specific content score among different type of website. Websites with HONcode certification were associated with higher DISCERN score, FBSS-specific content score, and JAMA benchmark criteria score than non-certified websites. The mean FKGL was 12.19 ± 2.20, and none of the websites' FKGL was lower than the six grade level. The quality and content of available online information for FBSS were poor. The readability of online information in our results showed a significantly higher reading level than the sixth-grade level recommended by the AMA and NIH. 4.

Accuracy and Reliability of Internet Resources Providing Information on Obstructive Sleep Apnea.

To evaluate the readability, content, and quality of internet information about obstructive sleep apnea (OSA). Three major search engines (Google, Yahoo, and Bing) were used to retrieve the first 200 hits for the term "sleep apnea." The website contents were assessed using established guidelines, while the website quality was evaluated using the validated DISCERN instrument and Journal of the American Medical Association benchmarks. In total, 243 websites met the inclusion criteria for this study. The websites were divided into five categories: scientific resource, foundation, news/ media report, commercial website, and personal commentary. The mean Flesch-Kincaid grade level, which indicated the readability of the websites, was 7.5. The quality of most websites was poor, with news/media reports and commercial websites exhibiting poorer quality than the others. The Health On the Net (HON) code, which certifies the reliability and credibility of online content regarding human health, was applied only to 14.3% websites; the reliability of all these websites was poor. The content score for the diagnosis and management of OSA was lower for news/media reports and commercial websites than for scientific resources. News/media reports exhibited the worst content scores. Our findings suggest that most online health resources regarding OSA are not reliable and are inaccurate. Health care providers should be aware of the high variability in online information concerning OSA. A commentary on this article appears in this issue on page 1643.

Factors Associated With Quality of Online Information on Trapeziometacarpal Arthritis.

People increasingly search the Internet for information about common medical problems such as trapeziometacarpal (TMC) joint arthritis. But this information can be biased, inaccurate, and misleading. Medical professionals should be aware of what patients may be reading about their condition because concepts and beliefs can affect symptoms, limitations, and decision making. This study sought factors associated with the quality of design and content of health information Web sites about TMC arthritis. Using 3 search engines we entered "thumb arthritis" and measured the quality of design and content of 67 Web sites using the DISCERN and LIDA tools, dominant tones using the IBM Watson Tone Analyzer, and readability, and we recorded Web site characteristics. All but 1 Web site exceeded the recommended sixth-grade reading level. We created 2 backward stepwise regression models to identify independent factors associated with Web site design and content quality. In multivariable analysis, the Web site not having a clear preference for treatment was independently associated with greater design and content quality measured by DISCERN. Health On the Net (HON) code certification-a code of conduct for medical Web sites-and nonprofit Web sites had higher LIDA scores. Online information on TMC arthrosis is difficult to read, often biased in favor of a particular treatment and influenced by profit and HONcode. Hand surgeons should prepare to gently correct misconceptions established or reinforced, in part, by material found on the Internet.

Predicting the quality of health web documents using their characteristics

PurposeThe quality of consumer-oriented health information on the web has been defined and evaluated in several studies. Usually it is based on evaluation criteria identified by the researchers and, so far, there is no agreed standard for the quality indicators to use. Based on such indicators, tools have been developed to evaluate the quality of web information. The HONcode is one of such tools. The purpose of this paper is to investigate the influence of web document features on their quality, using HONcode as ground truth, with the aim of finding whether it is possible to predict the quality of a document using its characteristics.Design/methodology/approachThe present work uses a set of health documents and analyzes how their characteristics (e.g. web domain, last update, type, mention of places of treatment and prevention strategies) are associated with their quality. Based on these features, statistical models are built which predict whether health-related web documents have certification-level quality. Multivariate analysis is performed, using classification to estimate the probability of a document having quality given its characteristics. This approach tells us which predictors are important. Three types of full and reduced logistic regression models are built and evaluated. The first one includes every feature, without any exclusion, the second one disregards the Utilization Review Accreditation Commission variable, due to it being a quality indicator, and the third one excludes the variables related to the HONcode principles, which might also be indicators of quality. The reduced models were built with the aim to see whether they reach similar results with a smaller number of features.FindingsThe prediction models have high accuracy, even without including the characteristics of Health on the Net code principles in the models. The most informative prediction model considers characteristics that can be assessed automatically (e.g. split content, type, process of revision and place of treatment). It has an accuracy of 89 percent.Originality/valueThis paper proposes models that automatically predict whether a document has quality or not. Some of the used features (e.g. prevention, prognosis or treatment) have not yet been explicitly considered in this context. The findings of the present study may be used by search engines to promote high-quality documents. This will improve health information retrieval and may contribute to reduce the problems caused by inaccurate information.

Quality evaluation of Chinese online chronic kidney information

Objective To investigate the quality of the chronic kidney information found on websites. Methods Three search engines were searched for relevant chronic kidney websites. The independent raters use HON code (The Health On Net Code of Conduct for medical and health Web sites, HON code) and DISCERN instrument to evaluate the chronic kidney websites in Chinese. Results A total of 18 websites were included into our study. The overall mean quality of HON code was 3.6±1.6. The overall mean quality of DISCERN instrument was 32.3 ±10.8. In the research site, the number of sites built by nonprofits accounted for only 5.6%(1/18). Conclusions The information quality on chronic kidney found online was of poor. The main reason is health websites contain lots of advertisement, and it is rare that non-profit websites can provide medical information which is suitable for general public, the overall reliability is poor, Chinese health websites need to put efforts on developing the quality of health information. Key words: Chronic kidney disease; Websites; Quality of information

Quality and readability of online patient information regarding sclerotherapy for venous malformations.

Patients often use the internet as a source of information about their condition and treatments. However, this information is unregulated and varies in quality. To evaluate the readability and quality of online information for pediatric and adult patients and caregivers regarding sclerotherapy for venous malformations. "Venous malformation sclerotherapy" was entered into Google, and results were reviewed until 20 sites that satisfied predefined inclusion criteria were identified. Scientific and non-patient-focused web pages were excluded. Readability was assessed using the Flesch Reading Ease Score and American Medical Association reading difficulty recommendations and quality was assessed using Journal of the American Medical Association standards and assessing if the site displayed HONcode (Health on the Net Code) certification. Assessment of the breadth of relevant information was made using a predefined checklist. Forty-nine search engine results were reviewed before 20 sites were identified for analysis. Average Flesch Reading Ease Score was 44 (range: 24.2-70.1), representing a "fairly difficult" reading level. None of the sites had a Flesch Reading Ease Score meeting the American Medical Association recommendation of 80-90. Only one site met all four Journal of the American Medical Association quality criteria (average: 2.1). None of the sites displayed a HONcode seal. The information most frequently found was: sclerotherapy is performed by radiologists, multiple treatments may be needed and surgery is an alternative treatment. Online information regarding sclerotherapy for venous malformations is heterogeneous in quality and breadth of information, and does not meet readability recommendations for patient information. Radiologists should be aware of and account for this when meeting patients.

Learning to parent from Google? Evaluation of available online health evidence for parents of preterm infants requiring neonatal intensive care.

The study aim was to identify and evaluate the reliability and quality of online resources for parents of preterm infants seeking health information about their infant using the DISCERN tool and Health on Net code. An Internet search ( www.google.com ) was used to identify websites for parents of preterm infants on their infants' health and health issues. For each search, the top 100 "hits" were downloaded, yielding 1200 websites. After reviewing websites for exclusion criteria and duplicates, 197 websites remained and were analyzed. According to the DISCERN tool, the websites had a moderate reliability score (mean = 29.88, standard deviation = 4.88, range: 18-40), moderate treatment score (mean = 24.15, standard deviation = 5.79, range: 10-35), and moderate overall quality score (mean = 3.41, standard deviation = 0.89, range: 1-5). Only 24 (12.2%) websites had current Health on Net code approval and no other websites met full eligibility for certification. Overall, the reliability and quality of information available online to parents of preterm infants is lacking.

Cosmetic facial surgery: are online resources reliable and do patients understand them?

Our aim was to assess the quality and readability of online resources regarding common cosmetic maxillofacial procedures. We searched Google for “rhytidectomy”, “rhinoplasty”, “orthognathic surgery”, “genioplasty”, “malar implants”, “blepharoplasty”, “otoplasty”, and related terms. In each case we assessed the top 50 results for quality and readability. Quality was measured using the DISCERN questionnaire, benchmark criteria published by the Journal of the American Medical Association (JAMA), and accreditation by the HONcode (Health On the Net code). The Flesch-Kincaid reading grade, Flesch reading ease score, Gunning’s fog index, and the Coleman-Liau index, were used to measure readability. A total of 350 sites were assessed and 200 were included in the study. The mean (SD) JAMA and DISCERN scores for all included websites indicated poor quality (0.49/4 (1.07) and 32.77/80 (10.57), respectively). Only eight sites (4%) were certified by the HONcode. There was a significant association between low DISCERN scores and Google Ads (p=0.009) and between low DISCERN scores and the websites of private clinicians or hospitals (p<0.001). The mean (SD) Flesch reading ease score and Gunning’s fog score both indicated poor readability that required a moderately high level of literacy (50.59 (11.82) and 13.83 (2.76), respectively). The Flesch-Kincaid and Coleman-Liau scores indicated similar results. Adherence to the JAMA benchmark, certification by the HONcode, and relevant selection on Google Ads would improve quality. The avoidance of medical jargon and use of shorter sentences would improve readability and provide patients with comprehensible explanations that would allow them to have realistic expectations and take responsibility for their own health.

Arabic websites relevant to patient information about spinal cord injury: Characteristics and quality assessment using the DISCERN tool

Background: Spinal cord injury (SCI) requires special healthcare and rehabilitation. Objective: The article describes and qualitatively assesses Arabic websites relevant to patient information about SCI. Materials and Methods: In March 2018, Google was searched using the Arabic translation of SCI. The first 100 results were assessed against inclusion and exclusion criteria. The following data were collected: Website name, URL, its category, SCI topic, and whether Health on the Net (HON) code was included in this study. In addition, the quality of them was assessed using the DISCERN tool. Results: A total of 13 websites were included in this study. Only two websites included HON code. Majority of them (>10) included information about the definition of SCI, its causes and its complications. Eight of them mentioned available treatment options. Most of them were blogs. Two of them were from hospital that is advertising for their SCI healthcare. According to the quality level assessment, 30.8% were of poor quality, 23.7% were of fair quality, 23.7% were of good quality, and 23.7% were of excellent quality. Conclusion: This study shows that the current available Arabic websites with SCI are insufficient. Moreover, their quality needs to be improved. In addition, there is no available governmental or institutional website with patient information about the topic. Governments, universities, and associations are encouraged to fill this gap to prevent probable patient risks that may arise from it. Some recommendations regarding quality improvement are provided.

Comparison of the Source and Quality of Information on the Internet Between Anterolateral Ligament Reconstruction and Anterior Cruciate Ligament Reconstruction: An Australian Experience.

Background:The internet is a valuable tool, but concerns exist regarding the quality and accuracy of medical information available online.Purpose:To evaluate the source and quality of information on the internet relating to anterolateral ligament reconstruction (ALLR) compared with anterior cruciate ligament reconstruction (ACLR).Study Design:Cross-sectional study.Methods:A questionnaire was administered to 50 ACLR patients in Australia to determine their use of the internet to research their operation and their familiarity with the anterolateral ligament (ALL) of the knee. The most common search terms were determined, and the first 70 websites returned by the 5 most popular search engines were used to assess the quality of information about ACLR and ALLR. Each site was categorized by type and was assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel specific content score for each procedure. The presence of the Health on the Net Code (HONcode) seal was also recorded.Results:The majority (84%) of ACLR patients used the internet to research their operation. The quality of information available for ALLR was significantly inferior to that for ACLR according to the DISCERN score (37.3 ± 3.4 vs 54.4 ± 4.6; P < .0001) and specific content score (5.3 ± 1.3 vs 11.0 ± 1.5; P < .0001). ACLR websites were predominantly physician produced, while the majority of ALLR websites were academic. In contrast to ACLR websites, the majority of ALLR websites did not provide information on the indication for treatment or potential complications. ALLR websites scored better on the JAMA benchmark criteria due to the predominance of academic websites. A greater proportion of ACLR websites (14.6%) versus ALLR websites (2.5%) provided an HONcode seal. Correlation was demonstrated between the DISCERN score and specific content scores for both ACLR and ALLR but not with JAMA benchmark criteria. The specific content score had high reliability for both ACLR and ALLR.Conclusion:The majority of patients undergoing ACLR in Australia used the internet to research the procedure. The quality of information on the internet relating to ALLR was significantly inferior to information about ACLR. Most ALLR websites failed to include crucial information about the indication or options for treatment, prognosis, and potential complications. Surgeons should be aware of the information to which their patients are exposed through the internet and should be proactive in directing patients to appropriate websites.

Comparison of Online Dementia Information in Chinese and in English Languages

IntroductionThere is a deficit of avenues for obtaining dementia information in the Asian American community. This study aims to compare the content and quality differences between websites providing information on dementia as found by a Google search conducted both in simplified Chinese characters and in English.MethodsA Google search was performed for the phrase “dementia” in simplified Chinese characters and in English. The resultant websites were categorized by whether they were commercial in nature, the type of website, and whether the website provided an explanation of dementia signs and symptoms. The quality of the websites was assessed via readability and the Health on the Net Code of Conduct (HONcode). Chi-squared analyses were performed to establish differences between the English and simplified Chinese results.ResultsThe simplified Chinese search websites were more likely to be commercial (p=0.045) and were more likely to not meet HONcode standards (p=0.008). No statistical significance was observed between the types of websites (p=0.127), the prevalence of signs and symptom explanations (p=0.073), and the readability of the website (p=0.151).ConclusionThe quality of websites obtained from the simplified Chinese character Google search was lower than those obtained from searches using the English language. Given the limited sources of language and culturally appropriate information on dementia, improvement of Internet resources may help to improve health outcomes of dementia patients in the Asian American population.

Assessing the Quality and Content of Accessible Information on the Internet Regarding Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: The internet has grown into one of the biggest resource of easy accessible health information for the general public. Hallux rigidus (HR) is the most common arthritic disease pattern of the foot. There is no mutual consent on the ideal operative intervention for this disease. State of knowledge is essential for a decision to proceed with a HR specific treatment, since this decision is ultimately a shared one between the patient and the physician. Therefore, many patients comb through the internet for medical information related to this specific topic. The purpose of this study was to assess the quality and integrity of the online available informative content about HR using acknowledged scoring instruments, proven quality markers and a novel designed specific HR score. Methods: In December 2016 the search term “hallux rigidus” was used to search Google (Google Inc., Mountain View, CA, USA) by three independent reviewers (two experienced orthopedic surgeons and one trained medical student). The content of the first 50 hits were analyzed by the use of specific scores including the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria and the Health On the Net code (HONcode) as a seal of quality for providing complete and transparent health-related information. Also the Flesch Reading Ease (FRE), the Flesch Kincaid Grade Level (FKGL), and the Gunning Fog Index (GFI) were recorded as indicators for readability. Websites were classified as follows: academic, commercial, government or non-profit organization (NPO), physician or group, and unspecified. A HR-specific content score was developed consisting of 19 specified items to evaluate the overall aspects about the procedure, management and potential complications. Results: Of the 50 screened websites, 37 (74%) were included for analysis. Of these 37 websites, 20 were from a physician or group, 8 were commercial, 6 were academic, 3 were governmental or NPO and 1 was unspecified. The mean DISCERN score of the websites was 46±10. The highest score was 65 points, whereas the lowest was 21. HON Code certification was present in six (16%) and HON seal in two websites (5%). The FRE, RKGL and GFI were 43,2±14, 8,1±2, and 6,7±2 respectively. The HR specific content score was 7±3. Conclusion: Quality and content of accessible information on the internet on HR was analyzed by three individuals by various objective scores. 37 websites were included in the analysis. The majority of websites provided poor information on the management of HR. Patients need to be aware of this fact. In the future measures need to be taken to improve quality and content of HR related websites.