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Morimoto Y, Lian CPL, Lai C, Kyogoku S, Daida H. Health literacy in medical imaging: a scoping review of current evidence and future directions. Public Health 2024; 234:84-90. [PMID: 38968928 DOI: 10.1016/j.puhe.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE The importance of health literacy in medical imaging is well recognized, yet the current landscape remains inadequately understood. This study aims to explore the extent of health literacy studies contextualized to medical imaging. STUDY DESIGN Scoping review. METHODS A scoping review was conducted using three online bibliographic databases namely, PubMed, ScienceDirect, and CINAHL. We have adopted the concept of health literacy, as a clinical risk and personal asset, to guide this review. RESULTS Of 311 unique articles, 39 met our selection criteria. Five themes (categories) were identified by the authors: appropriate communication with patients who receive medical imaging test results, appropriate usage of medical imaging, classes and characteristics of eHealth literacy, disease/deterioration prevention, and patient education. Additionally, 17 health literacy assessment tools were identified, including 11 original creations. Finally, 11 recommendations have emerged from this scoping review, offering valuable insights into methods, considerations, and strategies for promoting health literacy. CONCLUSIONS Health literacy studies in medical imaging cover both clinical and public health perspectives, benefiting diverse populations, regardless of underlying medical conditions. Notably, the majority of assessment tools used in these studies were author-generated, hindering cross-study comparisons. Given the innate capacity of medical images to convey intuitive information, those images do not solely benefit the patients who are given medical imaging examinations, but they also hold significant potential to enhance public health literacy. Health literacy and medical imaging are closely associated and mutually reinforce each other.
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Affiliation(s)
- Yuh Morimoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Cheryl Pei Ling Lian
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
| | - Christopher Lai
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Shinsuke Kyogoku
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Tokyo, Japan
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Vazquez S, Berke C, Lu VM, Wu EM, Silva MA, Das A, Soldozy S, Dominguez JF, Wang S. Pediatric Patients with Intracranial Arteriovenous Malformations: Trends in Emergency Room Presentation. World Neurosurg 2024; 188:e297-e304. [PMID: 38796143 DOI: 10.1016/j.wneu.2024.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Pediatric intracranial arteriovenous malformation (AVM) patients are commonly admitted to the emergency room (ER). Increasing patient utilization of the ER has been associated with healthcare disparities and a trend of decreased efficiency. The aim of this study was to evaluate the trends of pediatric AVM ER admissions over recent years and identify factors associated with health care resource utilization and outcomes. METHODS The 2016-2019 National Inpatient Sample was queried for patients under the age of 18 admitted with AVM. Cases of admission through the ER were identified. Demographic and severity factors associated with ER admission were explored using comparative and regression statistics. RESULTS Of 3875 pediatric patients with AVM admitted between 2016 and 2019, 1280 (33.0%) were admitted via the ER. Patients admitted via the ER were more likely to be in the lowest median income category (P < 0.001), on Medicaid insurance (P = 0.008), or in the South (P < 0.001) than patients admitted otherwise. There was increased severity and increased rates of intracranial hemorrhage (ICH) in patients admitted via the ER (P < 0.001). Finally, there were increasing trends in ER admissions and ICH throughout the years. CONCLUSIONS ER admission of pediatric AVM patients with ICH is increasing and is associated with a distinct socioeconomic profile and increased healthcare resource utilization. These findings may reflect decreased access to more advanced diagnostic modalities, primary care, and other important resources. Identifying populations with barriers to care is likely an important component of policy aimed at decreasing the risk of severe disease presentation.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, New York, USA.
| | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eva M Wu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ankita Das
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Shelly Wang
- Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA
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Smith ER. Editorial. A terrible border wall: a study of pediatric moyamoya exposes socioeconomic barriers to care in the United States. J Neurosurg Pediatr 2022; 29:599-601. [PMID: 35334458 DOI: 10.3171/2022.1.peds226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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DeBenedectis CM, Spalluto LB, Americo L, Bishop C, Mian A, Sarkany D, Kagetsu NJ, Slanetz PJ. Health Care Disparities in Radiology-A Review of the Current Literature. J Am Coll Radiol 2022; 19:101-111. [PMID: 35033297 DOI: 10.1016/j.jacr.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
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Affiliation(s)
- Carolynn M DeBenedectis
- Vice-Chair, Education; Director, Radiology Residency Program; Department of Radiology, President-elect, New England Roentgen Ray Society; and Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Lucy B Spalluto
- Vice-Chair, Health Equity; Director, Women in Radiology; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research; and Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Lisa Americo
- Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Casey Bishop
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Asim Mian
- Director, Radiology Residency Program; Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - David Sarkany
- Director, Radiology Residency Program; Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Nolan J Kagetsu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priscilla J Slanetz
- Vice-Chair, Academic Affairs; Associate Program Director, Radiology Residency Program, Boston Medical Center; President-elect Massachusetts Radiologic Society; Secretary, Association of University Radiologists; Chair, Breast Imaging Panel 2, ACR Appropriateness Guidelines Committee; and Department of Radiology, Boston Medical Center, Boston, Massachusetts
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Delaney FT, Doinn TÓ, Broderick JM, Stanley E. Readability of patient education materials related to radiation safety: What are the implications for patient-centred radiology care? Insights Imaging 2021; 12:148. [PMID: 34674063 PMCID: PMC8531160 DOI: 10.1186/s13244-021-01094-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Increasing numbers of patients and carers rely on online resources for healthcare information. Radiation safety can be misunderstood by patients and clinicians and lead to patient anxiety. We aimed to assess the readability of online patient educational materials (PEMs) related to radiation safety. METHODS A total of 84 articles pertaining to radiation safety from 14 well-known online resources were identified. PEMs were then analysed using Readability Studio Professional Edition Version 2019. Readability was assessed using eight different instruments: the Flesch-Kincaid Reading Grade Level, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST, Gunning Fog, and Flesch Reading Ease Score formula. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level using 1-sample t-tests. RESULTS The cumulative mean RGL for all 84 articles was 13.3 (range = 8.6-17.4), and none were written at or below the 6th or 8th grade level. The cumulative mean RGL exceeded the 6th grade reading level by an average of 7.3 levels (95% CI, 6.8-7.8; p < 0.001) and the 8th grade level by an average of 5.3 grade levels (95% CI, 4.8-5.8; p < 0.001). The mean Flesch Reading Ease Score was 39/100 ('difficult'). CONCLUSION Currently available online PEMs related to radiation safety are still written at higher than recommended reading levels. Radiation safety is a topic in which the specialist training of radiologists is crucial in providing guidance to patients. Addressing the readability of online PEMs can improve radiology-patient communication and support the shift to a patient-centred model of practice.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - James M Broderick
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Emma Stanley
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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Patient Race/Ethnicity and Diagnostic Imaging Utilization in the Emergency Department: A Systematic Review. J Am Coll Radiol 2020; 18:795-808. [PMID: 33385337 DOI: 10.1016/j.jacr.2020.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Diagnostic imaging often is a critical contributor to clinical decision making in the emergency department (ED). Racial and ethnic disparities are widely reported in many aspects of health care, and several recent studies have reported a link between patient race/ethnicity and receipt of imaging in the ED. METHODS The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching three databases (PubMed, Embase, and the Cochrane Library) through July 2020 using keywords related to diagnostic imaging, race/ethnicity, and the ED setting, including both adult and pediatric populations and excluding studies that did not control for the important confounders of disease severity and insurance status. RESULTS The search strategy identified 7,313 articles, of which 5,668 underwent title and abstract screening and 238 full-text review, leaving 42 articles meeting the inclusion criteria. Studies were predominately conducted in the United States (41), split between adult (13) and pediatric (17) populations or both (12), and spread across a variety of topics, mostly focusing on specific anatomic regions or disease processes. Most studies (30 of 42 [71.4%]) reported an association between Black, African American, Hispanic, or nonwhite race/ethnicity and decreased receipt of imaging. CONCLUSIONS Despite heterogeneity among studies, patient race/ethnicity is linked with receipt of diagnostic imaging in the ED. The strength and directionality of this association may differ by specific subpopulation and disease process, and more efforts to understand potential underlying factors are needed.
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Disparities in care among patients presenting to the emergency department for urinary stone disease. Urolithiasis 2019; 48:217-225. [DOI: 10.1007/s00240-019-01136-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
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Hansberry DR, D'Angelo M, White MD, Prabhu AV, Cox M, Agarwal N, Deshmukh S. Quantitative analysis of the level of readability of online emergency radiology-based patient education resources. Emerg Radiol 2017; 25:147-152. [PMID: 29143222 DOI: 10.1007/s10140-017-1566-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/06/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology. METHODS Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales. The search terms included the following: abdominal ultrasound, abdominal aortic aneurysm, aortic dissection, appendicitis, cord compression, CT abdomen, cholecystitis, CT chest, diverticulitis, ectopic pregnancy, epidural hematoma, dural venous thrombosis, head CT, MRI brain, MR angiography, MRI spine, ovarian torsion, pancreatitis, pelvic ultrasound, pneumoperitoneum, pulmonary embolism, subarachnoid hemorrhage, and subdural hematoma. Any content that was not written for patients was excluded. RESULTS The 230 articles that were assessed were written, on average, at a 12.1 grade level. Only 2 of the 230 articles (1%) were written at the third to seventh grade recommended reading level set forth by the National Institutes of Health (NIH) and American Medical Association (AMA). Fifty-two percent of the 230 articles were written so as to require a minimum of a high school education (at least a 12th grade level). Additionally, 17 of the 230 articles (7.3%) were written at a level that exceeded an undergraduate education (at least a 16th grade level). CONCLUSIONS The majority of websites with emergency radiology-related patient education materials are not adhering to the NIH and AMA's recommended reading levels, and it is likely that the average reader is not benefiting fully from these information outlets. With the link between health literacy and poor health outcomes, it is important to address the online content in this area of radiology, allowing for patient to more fully benefit from their online searches.
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Affiliation(s)
- David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Michael D'Angelo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Michael D White
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Arpan V Prabhu
- Department of Radiation Oncology, University of Pittsburgh Hillman Cancer Institute, Pittsburgh, PA, 15213, USA
| | - Mougnyan Cox
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Sandeep Deshmukh
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA
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Hansberry DR, Donovan AL, Prabhu AV, Agarwal N, Cox M, Flanders AE. Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology. AJNR Am J Neuroradiol 2017; 38:1252-1256. [PMID: 28385883 PMCID: PMC7960072 DOI: 10.3174/ajnr.a5151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/25/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions. MATERIALS AND METHODS Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine. RESULTS Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant (P < .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine. CONCLUSIONS Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources.
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Affiliation(s)
- D R Hansberry
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - A L Donovan
- Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - A V Prabhu
- Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - N Agarwal
- Department of Neurological Surgery (N.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - M Cox
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - A E Flanders
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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