Patients' use of the Internet for medical information

To what extent is oral and maxillofacial surgery educational content posted on Instagram?

Hashtags on Instagram help users globally search for posts to their liking. This study aimed to determine who posts the most popular oral and maxillofacial surgery (OMS) hashtags on Instagram and to evaluate the impact of educational content. The posts were analyzed for the type of post and differences between content creators when posting OMS-related content. This cross-sectional study evaluated OMS content categorized by 36 hashtags. The top 9 posts with each hashtag were evaluated based on the type of content creator, if it was a video or picture, and if it was educational or for marketing purposes. 6 million posts existed among 36 hashtags. Regarding the categories of person/organization posting the content (US or non-US oral and maxillofacial surgeon, residency program, patient, and 'other'), the top posts (N = 295) were posted by 'other' and the least by 'residency program'. Among the posts by non-US oral and maxillofacial surgeons, there was 3.8-fold more marketing content, while among the posts by US oral and maxillofacial surgeons, there was 2-fold more educational content. Educational posts achieved the highest engagement in terms of 'likes'. This study highlights how oral and maxillofacial surgeons can educate the general population and expand their reach.

Age and neurocognition are associated with credibility evaluations of health websites

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Characterizing the Adoption and Experiences of Users of Artificial Intelligence-Generated Health Information in the United States: Cross-Sectional Questionnaire Study

BACKGROUND

OpenAI's ChatGPT is a source of advanced online health information (OHI) that may be integrated into individuals' health information-seeking routines. However, concerns have been raised about its factual accuracy and impact on health outcomes. To forecast implications for medical practice and public health, more information is needed on who uses the tool, how often, and for what.

OBJECTIVE

This study aims to characterize the reasons for and types of ChatGPT OHI use and describe the users most likely to engage with the platform.

METHODS

In this cross-sectional survey, patients received invitations to participate via the ResearchMatch platform, a nonprofit affiliate of the National Institutes of Health. A web-based survey measured demographic characteristics, use of ChatGPT and other sources of OHI, experience characterization, and resultant health behaviors. Descriptive statistics were used to summarize the data. Both 2-tailed t tests and Pearson chi-square tests were used to compare users of ChatGPT OHI to nonusers.

RESULTS

Of 2406 respondents, 21.5% (n=517) respondents reported using ChatGPT for OHI. ChatGPT users were younger than nonusers (32.8 vs 39.1 years, P<.001) with lower advanced degree attainment (BA or higher; 49.9% vs 67%, P<.001) and greater use of transient health care (ED and urgent care; P<.001). ChatGPT users were more avid consumers of general non-ChatGPT OHI (percentage of weekly or greater OHI seeking frequency in past 6 months, 28.2% vs 22.8%, P<.001). Around 39.3% (n=206) respondents endorsed using the platform for OHI 2-3 times weekly or more, and most sought the tool to determine if a consultation was required (47.4%, n=245) or to explore alternative treatment (46.2%, n=239). Use characterization was favorable as many believed ChatGPT to be just as or more useful than other OHIs (87.7%, n=429) and their doctor (81%, n=407). About one-third of respondents requested a referral (35.6%, n=184) or changed medications (31%, n=160) based on the information received from ChatGPT. As many users reported skepticism regarding the ChatGPT output (67.9%, n=336), most turned to their physicians (67.5%, n=349).

CONCLUSIONS

This study underscores the significant role of AI-generated OHI in shaping health-seeking behaviors and the potential evolution of patient-provider interactions. Given the proclivity of these users to enact health behavior changes based on AI-generated content, there is an opportunity for physicians to guide ChatGPT OHI users on an informed and examined use of the technology.

Is YouTube a Reliable and Quality Source on Unilateral Biportal Endoscopic Spine Surgery? A Cross-Sectional Study

OBJECTIVE

This study aimed to evaluate the quality and reliability of YouTube videos focusing on unilateral biportal endoscopic spine surgery, a novel technique for spinal decompression in degenerative spinal disease.

METHODS

This cross-sectional study, conducted in February 2023, involved an online search on YouTube using the term "unilateral biportal endoscopic spine surgery". Video popularity was assessed using the Video Power Index. Video reliability and quality were measured using the Global Quality Scale, the Journal of the American Medical Association benchmark criteria, and the modified DISCERN instrument.

RESULTS

Ninety-three videos were included for evaluation. Uploader profiles were categorized by continent, with 61.3% from Asia, 35.5% from the United States, 2.2% from Africa, and 1.1% from Australia. When comparing 3 groups as South Korea, United States, and other countries, no significant differences were observed in the technical characteristics of the videos. However, the educational quality and reliability of the videos were higher in those uploaded from South Korea (P < 0.001).When the videos were divided into 2 groups according to their educational quality, significant difference were noted in video duration, loading time, video quality, and reliability (P < 0.001).

CONCLUSIONS

The YouTube videos on unilateral biportal endoscopic spine surgery showed high quality and reliability. However, videos from South Korea were found to have higher educational quality and reliability, while other specifications were similar for all videos. Furthermore, it was determined that videos uploaded more recently and with longer duration were of higher quality.

Google Bard and ChatGPT in Orthopedics: Which Is the Better Doctor in Sports Medicine and Pediatric Orthopedics? The Role of AI in Patient Education

BACKGROUND

This study evaluates the potential of ChatGPT and Google Bard as educational tools for patients in orthopedics, focusing on sports medicine and pediatric orthopedics. The aim is to compare the quality of responses provided by these natural language processing (NLP) models, addressing concerns about the potential dissemination of incorrect medical information.

METHODS

Ten ACL- and flat foot-related questions from a Google search were presented to ChatGPT-3.5 and Google Bard. Expert orthopedic surgeons rated the responses using the Global Quality Score (GQS). The study minimized bias by clearing chat history before each question, maintaining respondent anonymity and employing statistical analysis to compare response quality.

RESULTS

ChatGPT-3.5 and Google Bard yielded good-quality responses, with average scores of 4.1 ± 0.7 and 4 ± 0.78, respectively, for sports medicine. For pediatric orthopedics, Google Bard scored 3.5 ± 1, while the average score for responses generated by ChatGPT was 3.8 ± 0.83. In both cases, no statistically significant difference was found between the platforms (p = 0.6787, p = 0.3092). Despite ChatGPT's responses being considered more readable, both platforms showed promise for AI-driven patient education, with no reported misinformation.

CONCLUSIONS

ChatGPT and Google Bard demonstrate significant potential as supplementary patient education resources in orthopedics. However, improvements are needed for increased reliability. The study underscores the evolving role of AI in orthopedics and calls for continued research to ensure a conscientious integration of AI in healthcare education.

How artificial intelligence can provide information about subdural hematoma: Assessment of readability, reliability, and quality of ChatGPT, BARD, and perplexity responses

Subdural hematoma is defined as blood collection in the subdural space between the dura mater and arachnoid. Subdural hematoma is a condition that neurosurgeons frequently encounter and has acute, subacute and chronic forms. The incidence in adults is reported to be 1.72-20.60/100.000 people annually. Our study aimed to evaluate the quality, reliability and readability of the answers to questions asked to ChatGPT, Bard, and perplexity about "Subdural Hematoma." In this observational and cross-sectional study, we asked ChatGPT, Bard, and perplexity to provide the 100 most frequently asked questions about "Subdural Hematoma" separately. Responses from both chatbots were analyzed separately for readability, quality, reliability and adequacy. When the median readability scores of ChatGPT, Bard, and perplexity answers were compared with the sixth-grade reading level, a statistically significant difference was observed in all formulas (P < .001). All 3 chatbot responses were found to be difficult to read. Bard responses were more readable than ChatGPT's (P < .001) and perplexity's (P < .001) responses for all scores evaluated. Although there were differences between the results of the evaluated calculators, perplexity's answers were determined to be more readable than ChatGPT's answers (P < .05). Bard answers were determined to have the best GQS scores (P < .001). Perplexity responses had the best Journal of American Medical Association and modified DISCERN scores (P < .001). ChatGPT, Bard, and perplexity's current capabilities are inadequate in terms of quality and readability of "Subdural Hematoma" related text content. The readability standard for patient education materials as determined by the American Medical Association, National Institutes of Health, and the United States Department of Health and Human Services is at or below grade 6. The readability levels of the responses of artificial intelligence applications such as ChatGPT, Bard, and perplexity are significantly higher than the recommended 6th grade level.

Readability of patient education material in stroke: a systematic literature review

BACKGROUND

Stroke education materials are crucial for the recovery of stroke patients, but their effectiveness depends on their readability. The American Medical Association (AMA) recommends patient education materials be written at a sixth-grade level. Studies show existing paper and online materials exceed patients' reading levels and undermine their health literacy. Low health literacy among stroke patients is associated with worse health outcomes and decreased efficacy of stroke rehabilitation.

OBJECTIVE

We reviewed the readability of paper (i.e brochures, factsheets, posters) and online (i.e American Stroke Association, Google, Yahoo!) stroke patient education materials, reading level of stroke patients, accessibility of online health information, patients' perceptions on gaps in stroke information, and provided recommendations for improving readability.

METHOD

A PRISMA-guided systematic literature review was conducted using PUBMED, Google Scholar, and EbscoHost databases and "stroke", "readability of stroke patient education", and "stroke readability" search terms to discover English-language articles. A total of 12 articles were reviewed.

RESULTS

SMOG scores for paper and online material ranged from 11.0 - 12.0 grade level and 7.8 - 13.95 grade level respectively. Reading level of stroke patients ranged from 3rd grade to 9th grade level or above. Accessibility of online stroke information was high. Structured patient interviews illustrated gaps in patient education materials and difficulty with comprehension.

CONCLUSION

Paper and online patient education materials exceed the reading level of stroke patients and the AMA recommended 6th grade level. Due to limitations in readability, stroke patients are not being adequately educated about their condition.

"You're Not Alone": How Adolescents Share Dysmenorrhea Experiences Through Vlogs

Many adolescents experience severe pain during menstruation, yet their attempts to receive medical attention to alleviate or manage this pain are often met with dismissal or disbelief. In light of these barriers to care, many adolescents turn to social media to share their experiences with menstruation and pain, as well as hear from other members of their community. In this study, we investigated how adolescents present their experiences with menstruation in vlogs (or "video blogs"). Using critical qualitative methods and a four-column analysis structure, we transcribed and thematically analyzed the audio and video content of 17 YouTube vlogs wherein adolescents described their experiences with menstrual pain. We found that stylistically, the vloggers modulated between a polished documentary style and an intimate storytime style of video production. We additionally found that vloggers spoke about their menstrual pain experiences from three perspectives: as a Patient managing and diagnosing physical symptoms, as a Self considering how the pain affects their life and ambitions, and as a Teacher educating their audience. Considering both the visual and audio data, we discuss how healthcare providers can use these findings to inform their approach to discussing menstrual pain with adolescents. We further discuss possible future directions for research into health story sharing on social media.

Quality of ChatGPT Responses to Frequently Asked Questions in Carpal Tunnel Release Surgery

Background

Although demonstrating remarkable promise in other fields, the impact of artificial intelligence (including ChatGPT in hand surgery and medical practice) remains largely undetermined. In this study, we asked ChatGPT frequently asked patient-focused questions surgeons may receive in clinic from patients who have carpel tunnel syndrome (CTS) and evaluated the quality of its output.

Methods

Using ChatGPT, we asked 10 frequently asked questions that hand surgeons may receive in the clinic before carpel tunnel release (CTR) surgery. Included questions were generated from the authors' own experiences regarding conservative and operative treatment of CTS.

Results

Responses from the following 10 questions were included: (1) What is CTS and what are its signs and symptoms? (2) What are the nonsurgical options for CTS? (3) Should I get surgery for CTS? (4) What is a CTR and how is it preformed? (5) What are the differences between open and endoscopic CTR? (6) What are the risks associated with CTR and how frequently do they occur? (7) Does CTR cure CTS? (8) How much improvement in my symptoms can I expect after CTR? (9) How long is the recovery after CTR? (10) Can CTS recur after surgery?

Conclusions

Overall, the chatbot provided accurate and comprehensive information in response to most common and nuanced questions regarding CTS and CTR surgery, all in a way that would be easily understood by many patients. Importantly, the chatbot did not provide patient-specific advice and consistently advocated for consultation with a healthcare provider.

Critical review of self-diagnosis of mental health conditions using artificial intelligence

The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.

Assessment of the Quality, Accountability, and Readability of Online Patient Education Materials for Optic Neuritis

Most cases of optic neuritis (ON) occur in women and in patients between the ages of 15 and 45 years, which represents a key demographic of individuals who seek health information using the internet. As clinical providers strive to ensure patients have accessible information to understand their condition, assessing the standard of online resources is essential. To assess the quality, content, accountability, and readability of online information for optic neuritis. This cross-sectional study analyzed 11 freely available medical sites with information on optic neuritis and used PubMed as a gold standard for comparison. Twelve questions were composed to include the information most relevant to patients, and each website was independently examined by four neuro-ophthalmologists. Readability was analyzed using an online readability tool. Journal of the American Medical Association (JAMA) benchmarks, four criteria designed to assess the quality of health information further were used to evaluate the accountability of each website. Freely available online information. On average, websites scored 27.98 (SD ± 9.93, 95% CI 24.96-31.00) of 48 potential points (58.3%) for the twelve questions. There were significant differences in the comprehensiveness and accuracy of content across websites (p < .001). The mean reading grade level of websites was 11.90 (SD ± 2.52, 95% CI 8.83-15.25). Zero websites achieved all four JAMA benchmarks. Interobserver reliability was robust between three of four neuro-ophthalmologist (NO) reviewers (ρ = 0.77 between NO3 and NO2, ρ = 0.91 between NO3 and NO1, ρ = 0.74 between NO2 and NO1; all p < .05). The quality of freely available online information detailing optic neuritis varies by source, with significant room for improvement. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide comprehensive information regarding non-therapeutic aspects of the disease. Ophthalmology organizations should be encouraged to create content that is more accessible to the general public.

Machine learning analysis of online patient questions regarding breast reconstruction

BACKGROUND

Social media has become a dominant educational resource for breast reconstruction patients. Rather than passively consuming information, patients interact directly with other users and healthcare professionals. While online information for breast reconstruction has been analyzed previously, a robust analysis of patient questions on online forums has not been conducted. In this study, the authors used a machine learning approach to analyze and categorize online patient questions regarding breast reconstruction.

METHODS

Realself.com was accessed and questions pertaining to breast reconstruction were extracted. Data collected included the date of question, poster's location, question header, question text, and available tags. Questions were analyzed and categorized by two independent reviewers.

RESULTS

522 preoperative questions were analyzed. Geographic analysis is displayed in Figure 1. Questions were often asked in the pre-mastectomy period (38.3%); however, patients with tissue expanders currently in place made up 28.5%. Questions were often related to reconstructive methods (23.2%), implant selection (19.5%), and tissue expander concerns (16.7%). Questions asked in the post-lumpectomy period were significantly more likely to be related to insurance/cost and reconstructive candidacy (p < 0.01). The "Top 6″ patient questions were determined by machine learning analysis, and the most common of which was "Can I get good results going direct to implant after mastectomy?"

CONCLUSIONS

Analysis of online questions provides valuable insights and may help inform our educational approach toward our breast reconstruction patients. Our findings suggest that questions are common throughout the reconstructive process and do not end after the initial consultation. Patients most often want more information on the reconstructive options, implant selection, and the tissue expansion process.

YouTube as a source of information for pressure injury: Quality assessment and content analysis

We aimed to assess the quality and reliability of pressure injury-related videos uploaded on YouTube, analyse the sources and contents, and examine the correlation between video parameters. We searched YouTube using two keywords, "pressure ulcer" and "pressure sore", on August 20, 2022. We sorted the videos according to their number of views and included the top 100 videos for each keyword. The quality of videos was assessed using the Global Quality Scale (GQS), while their reliability was evaluated by the modified DISCERN (mDISCERN) tool. In addition, we evaluated the videos in which content was included, analysed the correlations and differences between GQS, mDISCERN, and video parameters. We initially found a total of 100 videos for each keyword and finally included and analysed 77 videos. The mean scores for the mDISCERN and GQS were 2.35 ± 0.98 and 3.09 ± 0.99, respectively. Both GQS and mDISCERN showed statistically significant correlations with each other (rho = 0.54, p < 0.0001*) and with the length of the videos, respectively (rho = 0.36, p = 0.001*), (rho = 0.29, p = 0.01*). Of the videos created by physicians, 8 (57.1%) included content related to treatment, while of the videos created by nonphysician health personnel, 22 (57.9%) included content related to prevention. Analysing whether there were differences in video parameters based on the sources, we observed significant differences between sources in GQS (p < 0.0001*), mDISCERN (p < 0.0001*), and video length (p = 0.001*). In the post-hoc analysis, videos uploaded by physicians or nonphysician health personnel showed higher quality and reliability than videos uploaded by other sources. Therefore, the results of this study could be useful for healthcare providers, as well as patients and caregivers, to search for high-quality and reliable YouTube videos related to pressure injury.

Quality assessment of online patient information on upper gastrointestinal endoscopy using the modified Ensuring Quality Information for Patients tool

INTRODUCTION

Websites and online resources are increasingly becoming patients' main source of healthcare information. It is paramount that high quality information is available online to enhance patient education and improve clinical outcomes. Upper gastrointestinal (UGI) endoscopy is the gold standard investigation for UGI symptoms and yet little is known regarding the quality of patient orientated websites. The aim of this study was to assess the quality of online patient information on UGI endoscopy using the modified Ensuring Quality Information for Patients (EQIP) tool.

METHODS

Ten search terms were employed to conduct a systematic review. for each term, the top 100 websites identified via a Google search were assessed using the modified EQIP tool. High scoring websites underwent further analysis. Websites intended for professional use by clinicians as well as those containing video or marketing content were excluded.

FINDINGS

A total of 378 websites were eligible for analysis. The median modified EQIP score for UGI endoscopy was 18/36 (interquartile range: 14-21). The median EQIP scores for the content, identification and structure domains were 8/18, 1/6 and 9/12 respectively. Higher modified EQIP scores were obtained for websites produced by government departments and National Health Service hospitals (p=0.007). Complication rates were documented in only a fifth (20.4%) of websites. High scoring websites were significantly more likely to provide balanced information on risks and benefits (94.6% vs 34.4%, p<0.001).

CONCLUSIONS

There is an immediate need to improve the quality of online patient information regarding UGI endoscopy. The currently available resources provide minimal information on the risks associated with the procedure, potentially hindering patients' ability to make informed healthcare decisions.

Study to evaluate the readability and visual appearance of online resources for blunt chest trauma: an evaluation of online resources using mixed methods

OBJECTIVES

Blunt chest trauma (BCT) is characterised by forceful and non-penetrative impact to the chest region. Increased access to the internet has led to online healthcare resources becoming used by the public to educate themselves about medical conditions. This study aimed to determine whether online resources for BCT are at an appropriate readability level and visual appearance for the public.

DESIGN

We undertook a (1) a narrative overview assessment of the website; (2) a visual assessment of the identified website material content using an adapted framework of predetermined key criteria based on the Centers for Medicare and Medicaid Services toolkit and (3) a readability assessment using five readability scores and the Flesch reading ease score using Readable software.

DATA SOURCES

Using a range of key search terms, we searched Google, Bing and Yahoo websites on 9 October 2023 for online resources about BCT.

RESULTS

We identified and assessed 85 websites. The median visual assessment score for the identified websites was 22, with a range of -14 to 37. The median readability score generated was 9 (14-15 years), with a range of 4.9-15.8. There was a significant association between the visual assessment and readability scores with a tendency for websites with lower readability scores having higher scores for the visual assessment (Spearman's r=-0.485; p<0.01). The median score for Flesch reading ease was 63.9 (plain English) with a range of 21.1-85.3.

CONCLUSIONS

Although the readability levels and visual appearance were acceptable for the public for many websites, many of the resources had much higher readability scores than the recommended level (8-10) and visually were poor.Better use of images would improve the appearance of websites further. Less medical terminology and shorter word and sentence length would also allow the public to comprehend the contained information more easily.

Assessment of usefulness and reliability of YouTube™ videos on denture care

INTRODUCTION

The world's population is in a demographic transition with a rising ageing population. Tooth loss is frequent among older people resulting in the replacement of natural teeth using complete or partial dentures. YouTube™ is the second most popular website in the world and is being increasingly used to access health care information. The aim of this study is to evaluate the usefulness and reliability of the information in YouTube™ videos regarding denture care.

METHODS

The YouTube™ website was used to systematically search for videos using the keyword 'denture care'. Videos meeting the eligibility criteria were assessed separately by two independent researchers. The usefulness of the videos was assessed using the Global Quality Assessment Scale and a customized usefulness scoring scheme. Based on these scores, the usefulness of the videos was categorized as low, medium and high. A modified DISCERN tool (mDISCERN) was used for assessing reliability with scores ranging from 0 to 5. Other video characteristics like source/ownership of the videos, duration, views, likes, dislikes, number of days posted, like ratio, view ratio, interaction index and Video Power Index were also obtained. Statistical analysis was carried out using the Kruskal-Wallis test, Spearman correlation test and multiple linear regression analysis.

RESULTS

A total of 120 videos were included. Based on the usefulness score, the usefulness of 65.8% of videos were classified as low, 32.5% were medium and 1.6% had high usefulness. The mDISCERN score for 74.2% of videos was 2 or below 2 indicating that the majority of videos had low reliability. Video characteristics did not differ significantly according to the usefulness of videos. Videos uploaded by dentists or dental hygienists had significantly higher usefulness scores (p < 0.001) in comparison to videos uploaded by other sources. However, reliability scores did not differ based on the sources of the videos. Video reliability was found to have a significant (B = 2.08, p < 0.001) positive association with video usefulness.

CONCLUSION

YouTube™ cannot be recommended as the only source of information for denture care as most videos received low usefulness and reliability ratings in our study. Dentists and dental health professionals could take an active part in enhancing denture care-related content on YouTube™ and enable patients to have adequate and reliable knowledge of denture hygiene practices.

Exploring the Intersection of Artificial Intelligence and Neurosurgery: Let us be Cautious With ChatGPT

BACKGROUND AND OBJECTIVES

ChatGPT is a novel natural language processing artificial intelligence (AI) module where users enter any question or command and receive a single text response within seconds. As AI becomes more accessible, patients may begin to use it as a resource for medical information and advice. This is the first study to assess the neurosurgical information that is provided by ChatGPT.

METHODS

ChatGPT was accessed in January 2023, and prompts were created requesting treatment information for 40 common neurosurgical conditions. Quantitative characteristics were collected, and four independent reviewers evaluated the responses using the DISCERN tool. Prompts were compared against the American Association of Neurological Surgeons (AANS) "For Patients" webpages.

RESULTS

ChatGPT returned text organized in paragraph and bullet-point lists. ChatGPT responses were shorter (mean 270.1 ± 41.9 words; AANS webpage 1634.5 ± 891.3 words) but more difficult to read (mean Flesch-Kincaid score 32.4 ± 6.7; AANS webpage 37.1 ± 7.0). ChatGPT output was found to be of "fair" quality (mean DISCERN score 44.2 ± 4.1) and significantly inferior to the "good" overall quality of the AANS patient website (57.7 ± 4.4). ChatGPT was poor in providing references/resources and describing treatment risks. ChatGPT provided 177 references, of which 68.9% were inaccurate and 33.9% were completely falsified.

CONCLUSION

ChatGPT is an adaptive resource for neurosurgical information but has shortcomings that limit the quality of its responses, including poor readability, lack of references, and failure to fully describe treatment options. Hence, patients and providers should remain wary of the provided content. As ChatGPT or other AI search algorithms continue to improve, they may become a reliable alternative for medical information.

Readability Analysis of Online Breast Cancer Surgery Patient Education Materials from National Cancer Institute-Designated Cancer Centers Compared with Top Internet Search Results

BACKGROUND

The National Institutes of Health (NIH) recommends patient education materials reflect the average reading grade level of the US population. Due to the importance of shared decision-making in breast cancer surgery, this study evaluates the reading level of patient education materials from National Cancer Institute-designated cancer centers (NCI-DCC) compared with top Internet search results.

METHODS

Online materials from NCI-DCC and top Internet search results on breast cancer, staging, surgical options, and pre- and postoperative expectations were analyzed using three validated readability algorithms: Simplified Measure of Gobbledygook Readability Formula, Coleman-Liau index, and Flesch-Kincaid grade level. Mean readability was compared across source groups and information subcategories using an unpaired t-test with statistical significance set at p < 0.05. Mean readability was compared using a one-way analysis of variance.

RESULTS

Mean readability scores from NCI-DCC and Internet groups ranged from a 9th-12th grade level, significantly above the NIH recommended reading level of 6th-7th grade. There was no significant difference between reading levels from the two sources. The discrepancy between actual and recommended reading level was most pronounced for "surgical options" at a 10th-12th grade level from both sources.

CONCLUSIONS

Patient education materials on breast cancer from both NCI-DCC and top Internet search results were written several reading grade levels higher than the NIH recommendation. Materials should be revised to enhance patient comprehension of breast cancer surgical treatment and guide patients in this important decision-making process to ultimately improve health outcomes.

Online Videos Regarding Relevant Postoperative Patient Information and Postoperative Rehabilitation After Arthroscopic Rotator Cuff Repair Provide Poor Information Quality, Accuracy, and Reliability

PURPOSE

To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair.

METHODS

By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos.

RESULTS

Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, β = 1.496 [P < .001]; GQS, β = 1.105 [P < .001]; DISCERN score, β = 11.234 [P < .001]; and RCS, β = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by non-medically trained individuals (P = .041).

CONCLUSIONS

The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair.

CLINICAL RELEVANCE

Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.

Assessment of the Quality and Reliability of YouTube as an Information Source for Transforaminal Interbody Fusion

BACKGROUND

This study aims to assess the quality and reliability of the information for patients from YouTube videos on transforaminal interbody fusion (TLIF).

MATERIAL AND METHODS

One hundred videos were listed by inputting "TLIF," "TLIF surgery," and "transforaminal interbody fusion" in the YouTube search engine. The top 50 most popular videos based on video power index (VPI), view ratio, and exclusion criteria were selected for review. One orthopedic consultant surgeon and one neurosurgeon consultant analyzed the videos together. The modified DISCERN score, the Global Quality Score (GQS), the Journal of the American Medical Association (JAMA) score, and a novel interbody fusion score were used to evaluate videos. Data of video length, view count, number of likes and dislikes, like ratio (like x 100/(like+dislike)), video source, and comment rate were collected.

RESULTS

The quality of the videos could have been better according to all scoring systems, regardless of the video source. The scores of the videos published by patients and commercials were significantly lower than those of physicians and allied professionals (p <0.05). VPI and view ratios were similar in all sources.  Conclusion: The study demonstrates that YouTube videos providing information related to TLIF surgery are available and accessed by the public. The results of this study would suggest that YouTube is not currently an appropriate source of information on TLIF surgery for patients. Most of the YouTube videos about TLIF surgery contain information about the surgical technique and have limited information about the post-operative condition of the patients.

Online Patient Education Materials on Iron Deficiency Anemia Are Too Difficult to Read and Low Quality: A Readability and Quality Analysis

Introduction Patients increasingly rely on online health information to understand and manage their diseases. Concerns about the quality and readability of these materials have been reported in the literature. Poor quality and difficult-to-read information lead to delayed diagnoses and adverse outcomes. We assessed the quality and readability of online health information about iron deficiency anemia (IDA) on Google. Method We searched for online web pages using the term "iron deficiency anemia"on Google. One hundred and twelve out of 200 web pages were included. We assessed web page typology, readability, the Journal of the American Medical Association (JAMA) score, the DISCERN score, and the Health on the Net Foundation certification (HONcode). Statistical analysis was performed with R version 4.2.2. Result Non-profit and scientific journal web pages were the most common. Scientific journal web pages were of the highest quality. News web pages were the most readable. The first Google Page web pages did not have greater JAMA scores or lower Flesch-Kinkaid Reading Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG) scores. Forty-six percent of all web pages were high-quality. Web pages on the first Google page were more likely to have HONCode certification. Conclusion We highlight gaps in the readability and quality of online information about IDA. Online web pages exceeded the recommended reading level for patients. Most web pages were low quality; only a quarter were HONcode-certified; and the first Google page web pages were not higher in quality than the later web pages on search.

Who can help me? Understanding the antecedent and consequence of medical information seeking behavior in the era of bigdata

Introduction

The advent of bigdata era fundamentally transformed the nature of medical information seeking and the traditional binary medical relationship. Weaving stress coping theory and information processing theory, we developed an integrative perspective on information seeking behavior and explored the antecedent and consequence of such behavior.

Methods

Data were collected from 573 women suffering from infertility who was seeking assisted reproductive technology treatment in China. We used AMOS 22.0 and the PROCESS macro in SPSS 25.0 software to test our model.

Results

Our findings demonstrated that patients' satisfaction with information received from the physicians negatively predicted their behavior involvement in information seeking, such behavior positively related to their perceived information overload, and the latter negatively related to patient-physician relationship quality. Further findings showed that medical information seeking behavior and perceived information overload would serially mediate the impacts of satisfaction with information received from physicians on patient-physician relationship quality.

Discussion

This study extends knowledge of information seeking behavior by proposing an integrative model and expands the application of stress coping theory and information processing theory. Additionally, it provides valuable implications for patients, physicians and public health information service providers.

Polycystic Ovary Syndrome (PCOS): A Cross-Sectional Observational Study Analyzing the Quality of Content on YouTube

INTRODUCTION

Polycystic ovary syndrome (PCOS), a chronic multifactorial disorder in women of reproductive age group, is a major public health problem. With most women resorting to platforms like "YouTube" that form a perfect source of edutainment, our aim was to analyze the quality of content available regarding the same.

AIMS

The aims and objectives of this study were to assess the quality and reliability of content related to PCOS on YouTube by analyzing the DISCERN score, global quality score (GQS), and video power index (VPI).

METHODOLOGY

It was a facility-based cross-sectional study undertaken on a single day with each author reviewing 10 videos from YouTube on PCOS using predetermined keywords. The number of likes, dislikes, views, comments, and uploader backgrounds were evaluated. DISCERN score, GQS, and VPI were also calculated for each video. While data entry was done using Microsoft Excel 2020 (Microsoft Corporation, Washington, United States), the analysis was carried out using SPSS Statistics version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Categorical variables were expressed as frequency and percentages, and statistical significance was determined using the Kruskal-Wallis test/one-way ANOVA.

RESULTS

A total of 80 videos that fit the inclusion criteria were analyzed. A majority of the videos (80%) were posted a year back with no updates. Only 28.8% of the video content was posted by doctors. Though most videos (96.25%) shared information pertaining to symptomatology, only 45% spoke regarding prevention. Promotional content was noted in 28.75% of the video content. GQS and VPI were better with information being provided by doctors, hospitals, and healthcare organizations (p-value 0.033 and 0.006, respectively).

CONCLUSIONS

With women reaching out to edutainment platforms like YouTube to clarify their concerns surrounding lifestyle diseases such as PCOS in the digital era, it becomes relevant to evaluate the quality of content available on such platforms. The findings of the study form a prototype for addressing the existing gaps in the knowledge available on YouTube. Furthermore, the findings warrant frequent monitoring of such available web-based content and delivery of such content only from qualified wellness experts.

Evaluation of acceptance, attitude, and knowledge towards artificial intelligence and its application from the point of view of physicians and nurses: A provincial survey study in Iran: A cross-sectional descriptive-analytical study

Background and Aims

The prospect of using artificial intelligence (AI) in healthcare is bright and promising, and its use can have a significant impact on cost reduction and decrease the possibility of error and negligence among healthcare workers. This study aims to investigate the level of knowledge, attitude, and acceptance among Iranian physicians and nurses.

Methods

This cross-sectional descriptive-analytical study was conducted in eight public university hospitals located in Tehran on 400 physicians and nurses. To conduct the study, convenient sampling was used with the help of researcher-made questionnaires. Statistical analysis was done by SPSS 21 The mean and standard deviation and Chi-square and Fisher's exact tests were used.

Results

In this study, the level of knowledge among the research subjects was average (14.66 ± 4.53), the level of their attitude toward AI was relatively favorable (47.81 ± 6.74), and their level of acceptance of AI was average (103.19 ± 13.70). Moreover, from the participant's perspective, AI in medicine is most widely used in increasing the accuracy of diagnostic tests (86.5%), identifying drug interactions (82.75%), and helping to analyze medical tests and imaging (80%). There was a statistically significant relationship between the variable of acceptance of AI and the participant's level of education (p = 0.028), participation in an AI training course (p = 0.022), and the hospital department where they worked (p < 0.001).

Conclusion

In this study, both the knowledge and the acceptance of the participants towards AI were proved to be at an average level and the attitude towards AI was relatively favorable, which is in contrast with the very rapid and inevitable expansion of AI. Although our participants were aware of the growing use of AI in medicine, they had a cautious attitude toward this.

How socioeconomically disadvantaged people access, understand, appraise, and apply health information: A qualitative study exploring health literacy skills

OBJECTIVES

Health literacy, or a person's competence to access, understand, appraise and apply health information, can be considered a mediating factor between socioeconomic characteristics and health disparities. Socioeconomically disadvantaged people in particular present with less health literacy skills. To develop targeted interventions tailored to their real needs, it is important to understand how they function and what difficulties they encounter when dealing with health information. The purpose of this study was to explore their experiences when accessing, understanding, appraising, and applying health information in their everyday lives.

METHODS

Semi-structured face-to-face interviews were conducted with 12 socioeconomically disadvantaged adults living in the community in Switzerland (age range: 44-60 years old).

RESULTS

Thematic analysis of the interviews yielded four themes, describing the health literacy processes of participants, related barriers, and compensatory strategies used: Financial insecurity triggers the need for health information; Pathway 1: Physicians as ideal (but expensive) interlocutors; Pathway 2: The internet as a suboptimal alternative; and Pathway 3: Relatives as a default resource. The progression of socioeconomically disadvantaged people in the health literacy process is like an 'obstacle course', with numerous steps taken backwards before they can develop compensatory strategies to overcome the barriers to obtaining health information.

CONCLUSIONS

Financial deprivation seems to be the most important factor contributing to health literacy barriers. Appraising health information is the health literacy skill with which socioeconomically disadvantaged people struggle the most. Physician-based, individual skills-based, organizational, and policy-based interventions are needed to help them overcome their health literacy challenges.

The Quality of Coronary Artery Bypass Grafting Videos on YouTube

Objective  YouTube (YouTube LLC, San Bruno, California, United States), one of the most accessed sites on the internet, has become a widespread source of healthcare information for patients. Videos about coronary artery bypass grafts (CABG) have accrued tens of millions of views on the platform, yet their educational quality is unknown. This study investigates the educational landscape of videos regarding CABG procedures on YouTube. Methods YouTube was queried for "Coronary Artery Bypass Graft Surgery" and "Coronary Artery Bypass Graft Procedure". After applying exclusion criteria, 73 videos were assessed. Two independent reviewers rated the material with the Global Quality Scale (GQS) (5 = high quality, 0 = low quality) to judge educational value. A ratio of view count to days since upload was applied to assess video popularity. Source, modality, and date of upload were recorded for each video as well. Results An average GQS score of 2.94 was found, indicating poor educational quality of the 73 YouTube videos on CABG procedures. Videos uploaded by physicians (56/73; 76.7%) had a significantly higher average GQS score than those uploaded by non-physicians (p<0.001). When content was grouped by delivery method, physician-led presentations (24/73 or 32.9%) produced the highest average GQS score of 3.35; conversely, patient-friendly delivery methods (18/73 or 24.7%) yielded the lowest average GQS score of 2.36 (p<0.001). Neither the view ratio nor the days since upload significantly correlated with the educational quality of the video. Conclusion Although CABG videos are readily available on YouTube, they often contain considerable biases and misleading information. With online sources for healthcare education now commonplace, physicians must be aware of the vast quantities of low-quality videos patients often encounter when weighing different treatment options. Further analysis of CABG videos on YouTube may allow physicians to ameliorate this gap by producing videos that are not only high quality but highly viewed on the platform.

Health Literacy in Oculofacial Plastic Surgery: A Literature Review

Patient satisfaction following oculofacial cosmetic procedures depends on preoperative expectations, which may be influenced by online material. Patients with poor health literacy are particularly vulnerable to misinformation and low-quality resources. However, few studies have evaluated the quality of online information on common oculofacial plastic surgeries and procedures. This study aimed to review the literature on the readability and quality of online material related to oculofacial plastic surgery. We conducted a systematic search of the PubMed/MEDLINE database and included 10 studies in our review. Among the readability scores reported in these studies, the lowest was 10, representing a tenth-grade reading level. Furthermore, the online materials were often rated as "poor" quality based on multiple grading scales. Our systematic review of the literature demonstrates that online materials covering common oculofacial plastic surgery procedures are consistently of poor quality and exceed the recommended readability level. Therefore, considering these online materials that influence patient expectations could enable oculofacial plastic surgeons to better tailor their preoperative counseling.

Quality and Readability of Accessible Facial Feminization Literature: Where Can We Improve?

BACKGROUND

Facial feminization surgery (FFS) consists of multiple, complex procedures. Well-informed patients have been shown to have better outcomes and expectations. However, there is limited data evaluating FFS patient-oriented material online. This study aims to evaluate the quality and readability of FFS literature online.

METHODS

Facial feminization surgery-related terms were queried in Google with location, cookies, and user account information disabled. Websites were analyzed for readability using Flesch Reading Ease and Flesch-Kincaid Reading Grade Level, suitability using the suitability assessment of materials (SAM), and quality using the DISCERN scale. Unpaired t tests and χ2 tests were used to compare the websites of community-based and academic or public institutions.

RESULTS

One hundred twenty websites met inclusion criteria (71 community-based and 49 academic). The average reading grade level was 11.68 ± 1.71. The average SAM score was 53.11 ± 11.75, denoting adequate readability. Only 16.67% of websites contained visual aids to assist in explaining procedures and benefits. Overall, 68.33% of websites' DISCERN score was rated very poor or poor, whereas only 8.33% were rated as good. The following DISCERN elements had the lowest scores across all graded websites: "clear source and date of information," "details of additional source of support," "refers to areas of uncertainty," and "describes risks of each treatment." Websites published by community-based institutions were significantly better in describing how FFS works and the benefits of each procedure. Academic sites overall were less biased (4.84 vs 4.62, P = 0.03) and provided additional sources of support (2.35 vs 1.32, P = <0.001).

CONCLUSIONS

Online FFS patient resources should be written at a more inclusive reading level and should increase the use of pictorial aids to improve patient comprehension. Facial feminization surgery patient resources were significantly above the recommended sixth grade reading level for health literature. Academic and community-based institutions should include more information about procedural risks and limitations in surgical outcomes to ensure a broader scope of understanding.

The quality and content of hyperthermic intraperitoneal chemotherapy information available to patients: An evaluation of North American hyperthermic intraperitoneal chemotherapy websites

BACKGROUND

Patients commonly use the internet to obtain medical information. Patients in our outpatient setting frequently have incomplete or even incorrect information about hyperthermic intraperitoneal chemotherapy that they have found on the internet. We aimed to assess the quality and content of Web-based information on hyperthermic intraperitoneal chemotherapy using validated and novel scoring systems.

METHODS

The keywords "HIPEC" and "hyperthermic intraperitoneal chemotherapy" were entered into the most commonly used internet search engines (Google, Bing, and Yahoo). The first 10 websites from each search were analyzed. Website quality was assessed using the validated Journal of the American Medical Association benchmark criteria and DISCERN scoring systems. We created a novel hyperthermic intraperitoneal chemotherapy-specific score with surgeon experts in the field.

RESULTS

Eighteen unique websites were identified. The majority (78%) were from academic institutions. The mean total DISCERN score for all websites was 41.8 ± 8.4 (maximum possible points = 75). The mean Journal of the American Medical Association and hyperthermic intraperitoneal chemotherapy-specific scores were 1.72 ± 1.13 (maximum possible score = 4) and 11.5 ± 4.5 (maximum possible score = 31), respectively. The lowest Journal of the American Medical Association scores were in the category of authorship. In total, 78% of websites omitted author details; 83% and 78% included the temperature and duration of hyperthermic intraperitoneal chemotherapy, respectively. Only 39% of websites mentioned complications of hyperthermic intraperitoneal chemotherapy.

CONCLUSION

Web-based information on hyperthermic intraperitoneal chemotherapy is of variable content and quality. None of the websites achieved maximum scores using any of the scoring tools. Less than half of the websites provided any information on possible complications of the procedure. These findings should be highlighted to patients using the internet to obtain information about hyperthermic intraperitoneal chemotherapy.

Assessment of quality and reliability of YouTube videos for patient and physician education on inflammatory myositis

INTRODUCTION

YouTube is the second most popular search website worldwide to access health information online. This study was undertaken to assess the reliability and quality of information about myositis on YouTube and delineate attributes of useful videos using standard metrics.

METHODS

We conducted a thorough search on YouTube using 9 search terms related to myositis. The inclusion criteria were content related to myositis, English language and acceptable audio-video quality. Duplicates and advertisements were excluded from the analysis. Videos were classified as useful, not very useful or misleading and patient narratives. Reliability was determined using the mDISCERN criteria, quality using the Global Quality Scale (GQS) and JAMA system, using appropriate cut-offs (mDISCERN > 4, GQS > 4, JAMA > 3).

RESULTS

Out of a total of 900 videos, 453 were included for the analysis. Seventy-four per cent and 2% provided useful and not very useful information respectively, while 24% were patient narratives. Seventy-one per cent were intended specifically for patients while 69% were for healthcare providers and students. Noteworthily, useful and not very useful videos had similar total views though the number of likes and daily viewership were higher for useful videos (p = 0.024, p = 0.046). Nearly half (47%) of useful videos were by professional medical societies/patient support groups (PSGs) while not very useful ones were by nonmedical media (38%). Physician-predicted usefulness was discordant with score-based usefulness (κ = 0.129). However, GQS emerged as a significant (p = 0.008) predictor of video usefulness in multivariate analysis.

CONCLUSION

A large majority of English YouTube videos on myositis provide useful information for patients. Physicians could signpost patients to high-quality useful videos as determined by GQS and sources like professional medical societies and PSGs. Key Points •This study highlights the importance of regulating health information posted online, accessed by millions of people, to gauge the quality of information and to identify and curb misinformation. •It also identifies recommendations for the future for uploading such content on the Internet. •The implications lie in our patients being better informed about their disease as they are important stakeholders in the healthcare decision-making process.

Improving Perioperative Preparation for Patients Undergoing Surgical Treatment for Distal Radius Fractures

We aimed to review common patient concerns after surgical repair of distal radius fracture (DRF) to identify potential interventions to improve the gap between expectation and education for DRF patients.

Methods

We conducted a retrospective cohort study of 100 consecutive patients who underwent surgical repair of DRF at a level I trauma center. Patient-initiated communication notes were reviewed with thematic analysis to identify the common reasons patients required additional information. We used the Patient Education Materials Assessment Tool to score the available educational resources for DRF patients for the understandability and actionability of the educational materials provided to the patients.

Results

Of 165 patient communication episodes, 88.5% occurred postoperatively. The most common concerns were pain (30, 15.4%) and surgical site changes (24, 12.3%). Most communications (171, 83.4%) were resolved with patient education through instruction or reassurance. The reviewed materials did not address pain or surgical site changes. No reviewed materials provided actionable steps patients could take to facilitate recovery.

Conclusions

Pain management and normal wound healing were the most common surgical concerns of DRF patients. We identify opportunities to improve expectation-setting in online materials and during face-to-face education to create a more patient-centered perioperative experience.

Content, Readability, and Accountability of Online Health Information for Patients Regarding Blue Light and Impact on Ocular Health

Objective To evaluate the quality and readability of online health content regarding the ocular health effects of blue light. Methods Five commercial and five non-commercial websites with content regarding the ocular effect of blue light were examined. Quality evaluations were conducted using a 14-question assessment composed by the authors and the 16-question DISCERN instrument. Website accountability was evaluated via the Journal of the American Medical Association (JAMA) benchmarks. Readability was determined using an online tool (Readable). Correlational and comparative analyses were conducted where appropriate. Results The average questionnaire score was 84 (standard deviation [SD] ± 17.89, 95% confidence interval [CI] 77.32-90.68) out of 136 points (61.8%). Significant differences in quality were identified between websites (p = 0.02), with Healthline achieving the highest score. Compared to commercial websites, non-commercial websites trended toward having significantly higher median questionnaire scores (p = 0.06). Zero websites achieved all four JAMA benchmarks. The average reading grade level of content was 10.43 (SD ± 1.15, 95% CI 9.60 - 11.25), with differences between websites trending toward significance (p = 0.09). There was no correlation between resource readability and quality (ρ = 0.28; p = 0.43) or accountability (ρ = 0.47; p = 0.17). Conclusions There remain substantial deficiencies in the quality, accountability, and readability of online content concerning the effect of blue light on ocular health. Clinicians and patients must recognize such issues when recommending and consuming these resources.

Pregnant women's use and attitude toward Mobile phone features for self-management

BACKGROUND

This study aimed to examine the current use of mobile phones by pregnant women and their attitudes towards the use of a variety of prenatal care services through mHealth.

METHODS

This descriptive cross-sectional study was conducted in Iran in 2021. The study population included 168 pregnant women who referred to specialist obstetrics and gynecology clinic. The data collection tool was a questionnaire that included the demographics of the participants, their current mobile phone usage, and their attitudes toward mobile phone use for prenatal care services. The data were analyzed in SPSS with descriptive and analytical statistics.

RESULTS

The majority of participants (84.2%) had a smartphone and access to mobile internet. More than half of the respondents (58.9%) used their mobile phone for (only) phone calls, and 36.7% occasionally used mobile internet to access prenatal care services. To get information about the pregnancy and to communicate with other pregnant women, the participants mainly used social media, and to get reminders, they preferred phone calls.

CONCLUSIONS

In this study, pregnant women have a positive attitude towards using mobile phones for obtaining health services and prefer social media to seek prenatal care services. There seems to be a need for pregnant women to have high levels of digital health literacy and be advised by healthcare providers on using this technology to access prenatal care services.

Social media may cause emergent SARMs abuse by athletes: a content quality analysis of the most popular YouTube videos

OBJECTIVES

Selective Androgen Receptor Modulators (SARMs) social media interest is at an all-time high. The aim of this study is to analyze the: (1) quality; (2) educational content; and (3) reliability of the most relevant YouTube videos on SARMs to explain growing SARMs abuse by recreational and professional athletes.

METHODS

'SARMs' was queried (28 November 2021) through the YouTube video library. The top 100 videos filtered by relevance were categorized by source, type of content, educational quality by Global Quality Score (GQS), reliability by Journal of American Medicine Association (JAMA) criteria, YouTube tags, attitude toward SARMs use, and whether the video provided specific support on how to use SARMs. For all outcome variables, descriptive statistics and comparison among source types and category types were performed.

RESULTS

Mean JAMA score was 1.6 ± 0.7 out of 4. Mean GQS score was 2.5 ± 1.1 out of 5. Patient videos were of lower educational quality than athletic trainer videos (GQS: 2.11 ± 0.95 vs. 2.95 ± 1.00, p < 0.01), and videos categorized as user experience were of lower educational quality than videos categorized as general SARMs information (GQS: 1.92 ± 0.90 vs. 2.72 ± 1.07, p < 0.05). User experience and dosing recommendation videos were statistically significantly more positive in attitude than both general SARMs information and SARMS vs. other PEDs.

CONCLUSION

Quality, content, and reliability of SARMs YouTube videos was low. Social media likely causes SARMs abuse through disseminating biased SARMs misinformation. These results serve to educate public health oversight bodies, healthcare providers, and sports team members to better identify signs of SARMs abuse, and promote discussion to discourage SARMs abuse.

Assessing the Quality of Patient Information for Cholesteatoma on the Video Sharing Platform YouTube

INTRODUCTION

Cholesteatoma is common chronic ear condition that usually requires surgical treatment and long-term follow-up. The Internet helps patients find information about their medical conditions and assists in shared clinical decision making. This work aims to assess the quality of information on YouTube for cholesteatoma. We aim to assess the quality of the most popular cholesteatoma videos on YouTube using recognized scoring systems and determine if quality correlated with video likes and views.

METHODS

The YouTube website was systematically searched on separate days with a formal search strategy to identify videos relevant to cholesteatoma. Each video was viewed and scored by three independent assessors using a novel Essential and Ideal Video Completeness criteria for cholesteatoma and the validated DISCERN tool. Popularity metrics were analyzed and compared with video popularity.

RESULTS

A total of 90 YouTube videos were analyzed with an average 55,292 views per video with an average of 271 likes and 22 dislikes. The interrater correlation was moderate with Fleiss kappa score 0.42 ( p < 0.01) using the Essential and Ideal Video Completeness criteria for cholesteatoma and interrater correlation coefficient was 0.78 (95% confidence interval, 0.58-0.90), indicating good reliability for DISCERN scores. The overall video quality was poor with higher DISCERN scores found from academic institutions.

CONCLUSION

YouTube content with regard to cholesteatoma is of poor quality. Videos with unclassified sources or more dislikes correlated with poor quality. Otology societies should be encouraged to publish high-quality YouTube videos on cholesteatoma and other ear conditions.

Assessment of Reliability and Quality of Videos on Medial Epicondylitis Shared on YouTube

Introduction Video-sharing websites, especially YouTube search engine, have become popular sources for obtaining health information over the years. The reliability and quality of contents on YouTube are unpredictable and questionable. The purpose of this study was to evaluate the reliability and quality of videos on medial epicondylitis shared on the YouTube platform. Methods A YouTube search with the keywords "medial epicondylitis" and "golfer's elbow" was conducted. After typing each keyword, the first 50 videos that appeared in the first three pages were evaluated. The titles and duration of the videos, the uploading sources, the time passed since the upload, number of total views, likes, dislikes and comments were recorded. All videos were analyzed and scored using the DISCERN scoring system, modified DISCERN (mod-DISCERN) scale, and the Global Quality Score (GQS). Results Eighty-eight videos met the inclusion criteria and were included in the study. The mean DISCERN score, mod-DISCERN score and GQS were 40.68±10.5, 1.81±0.76, and 2.72±0.9, respectively. Most of the videos had poor and very poor quality content according to the DISCERN instrument, the mod-DISCERN scale and GQS tool. The main upload sources were doctors (36.4%), physiotherapists (25%), patients (2.2%), and other (36.4%). The videos uploaded by doctors had higher quality scores than other uploading sources. Of the 88 videos, 10 were about diagnosis alone, 39 were on treatment alone, and 39 contained information about both of diagnosis and treatment. The mean DISCERN score, mod-DISCERN score and GQS of the videos on "both" were significantly higher than those "diagnosis alone" and "treatment alone" groups. Conclusion Nearly 80% of YouTube videos on medial epicondylitis according to the DISCERN and GQS tool, and also 97.7% of videos according to the mod-DISCERN scale had medium or poor quality. YouTube videos on medial epicondylitis could not be considered as accurate and reliable sources. Because the videos uploaded by doctors had higher quality scores, the physicians should prepare and upload more reliable and quality contents with detailed information on YouTube.

Evaluating the quality and readability of online information on keratoconus treatment

OBJECTIVE

This study aims to evaluate the quality and readability of online resources on keratoconus treatment.

METHODS

A Google.com search was conducted on August 9, 2020; 32 web sites were selected for analysis. Popularity was assessed by Google and Alexa rank. The quality of web sites was analyzed using the quality criteria for consumer health information (DISCERN) tool, the Journal of the American Medical Association (JAMA) benchmark, and the Health On the Net Code of Conduct Certification (HONcode). The readability of the web sites was assessed using the Fleschwebr hea Reading Ease, the Automated Readability Index, and the Fleschted Readability RESULTS: The JAMA benchmark scores, unlike the DISCERN scores, were correlated with the Google and Alexa rank. One web site (3.1%) met all the JAMA benchmark criteria, and 3 (9.3%) others had HONcode certification. The median DISCERN score was 33 (range, 29.6-43.1; maximum possible, 80). Rnib.org.uk scored the highest at 57 (71.0%). The mean Flesch-Kincaid Reading Ease score (52.9 ± 7.1) corresponded to uk" n DIdifficult to read." Thirty-one web sites (96.8%) had a Flesch-Kincaid Grade higher than the American Medical Association recommendation of sixth grade level. The median Automated Readability Index score was 7 (range, 6.2-7.3).

CONCLUSION

The majority of online information currently available on keratoconus treatment is complex and highly variable. Rnib.org.uk is the best currently available source. Clinicians should inform patients on how to assess the credibility of online information and recommend suitable information sources.

Is YouTube™ a good source of information for patients to understand laparoscopic fundoplication?

INTRODUCTION

Gastro-oesophageal reflux disease affects 10-20% of the population, and laparoscopic fundoplication is one management option. As the most frequently accessed video-sharing website, YouTube has become a popular source of information for patients. This study conducted a cross-sectional analysis of the quality and demographics of patient education videos available on YouTube for laparoscopic fundoplication.

METHODS

Three searches were performed on YouTube using the phrases 'laparoscopic fundoplication', 'heartburn surgery' and 'reflux operation'. The Health on The Net (HON) code, DISCERN and Journal of the American Medical Association (JAMA) systems were used to score the first 75 results from each query. Information about each video was collected, including number of views, time since posting, number of comments and the author of the video. Relationships between these variables and video quality were investigated.

RESULTS

The median number of views was 3,793. The most common author category was videos produced by surgeons. Overall the quality was poor, mean HON score was 2.5/8, mean DISCERN score was 29.3/80 and mean JAMA score was 1.5/4. Surgeon-authored videos scored higher when scored using the HON and JAMA systems. Videos of longer duration scored higher using all three scoring systems. No other factors were found to be associated with video quality.

CONCLUSION

The quality of information in YouTube videos on laparoscopic fundoplication is unreliable. Doctors should be aware of this and caution their patients of YouTube's limitations. Further research is needed to develop validated scoring systems for evaluating the quality of patient education videos.

Women Survivors of Adolescent Dating Violence Describe the Maintenance of Their Abusive Relationships: First Person Stories via YouTube

The current study explores the personal stories of young women on their own experiences with adolescent dating violence and focuses on their perceptions of the relevant factors that maintained the relationship over time. To this end, we analyzed seven publicly available videos on YouTube of women explaining their experiences of adolescent dating violence, including how they perceived their relationships to be maintained over time. We identified four major sources these survivors perceived as contributing to the maintenance of adolescent dating violence: the Self, the Partner, the Relational Dynamic, and Other People.

TLIF Online Videos for Patient Education-Evaluation of Comprehensiveness, Quality, and Reliability

Over the last few decades, the number of lumbar interbody fusion surgeries performed has been constantly increasing, with transforaminal lumbar interbody fusion (TLIF) being one of the most common surgical techniques. Due to easy accessibility, patients frequently use YouTube to obtain information on health-related issues. Consequently, online video platforms may be a valuable tool for patient education. The aim of this study was to assess the quality, reliability, and comprehensiveness of online videos on TLIF. We screened 180 videos on YouTube, yielding a total of 30 videos that met the inclusion criteria. These videos were evaluated using Global Quality Scale, DISCERN reliability tool, and JAMA Benchmark Score, and assessed in regard to their comprehensiveness and coverage of relevant aspects. At the time of rating, the videos had between 9188 and 1,530,408 views and between 0 and 3344 likes. The median rater assessment for all videos was "moderate quality". GQS and subjective grades showed a moderate to strong statistically significant association with views and likes. Considering this association of GQS and subjective grade with views and likes, these criteria could be used by laypersons to identify good-quality content. Nevertheless, there is an urgent need for peer-reviewed content that covers all of the relevant aspects.

Guideline-Nonconformant Investigational Treatments for Erectile Dysfunction: What are Patients Learning?

OBJECTIVE

To evaluate the validity of YouTube content on shockwave, platelet-rich plasma, and stem cell therapies for erectile dysfunction (ED). The consumerization of men's health is particularly notable among regenerative ED treatments, and the popularity of these treatments has been amplified by social media sites such as YouTube.

METHODS

We searched YouTube utilizing the following terms: "shockwave therapy-," "platelet-rich plasma- and "stem cell therapy-" "-for erectile dysfunction." The first 50 resulting videos per query were screened (inclusion criteria: relevant title/content, English language, >100 views) and judged by 2 independent graders using the validated DISCERN instrument for consumer health information. Regression analysis assessed association of video characteristics with DISCERN score.

RESULTS

Seventy-one unique videos met criteria. More content featured non-physicians (37%) or non-urologist physicians (35%) than urologists (28%). Mean DISCERN score was low at 42.8 of 80. DISCERN score significantly differed by video category and characteristics. Educational and urologist-featuring videos were associated with higher score. News reports were associated with lower score. Only 3 videos mentioned investigational/experimental status of the therapies. Only 2 cited society guidelines.

CONCLUSION

Most YouTube videos on regenerative ED therapies are unreliable and from non-urologists. The misrepresentation of proven efficacy may be encouraging patients to seek these still investigational treatments at high fiscal costs to the patient. Videos with urologists were more likely to be higher quality and guideline based. The urological and academic communities should continue to leverage the power of social media to provide evidence-backed consumer health information in this space.

Health literacy mediates the effects of educational attainment on online pharmacy navigation skills in older adults with HIV disease

ObjectiveThe Internet serves an increasingly critical role in health behaviors for older adults with chronic medical conditions. Guided by theories of health behaviors and literacy, this study examined whether the relationship between educational attainment and online pharmacy skills in older persons with HIV disease (PWH) is mediated by health literacy. Design: Participants included 98 PWH age 50 and older who completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate an experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). Participants also completed the Medication-Management Test-Revised (MMT-R). Results: Mediation analyses revealed a significant indirect effect of education on both online pharmacy accuracy and MMT-R, which was fully mediated by health literacy. In contrast, there was no direct or indirect effect of education on online pharmacy speed when health literacy was included as a mediator. Conclusion: Health literacy plays an important role in the relationship between years of education attained and the ability of older PWH to successfully navigate online pharmacy tasks and manage their medications. Future studies might examine whether interventions to improve electronic health literacy among older PWH who have lower educational attainment have beneficial effects on online health behaviors.

A critical readability and quality analysis of internet-based patient information on neck dissections

Objective

Patients are increasingly turning to the Internet as a source of healthcare information. Given that neck dissection is a common procedure within the field of Otolaryngology - Head and Neck Surgery, the aim of this study was to evaluate the quality and readability of online patient education materials on neck dissection.

Methods

A Google search was performed using the term "neck dissection." The first 10 pages of a Google search using the term "neck dissection" were analyzed. The DISCERN instrument was used to assess quality of information. Readability was calculated using the Flesch-Reading Ease, Flesch-Kincaid Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index.

Results

Thirty-one online patient education materials were included. Fifty-five percent (n = 17) of results originated from academic institutions or hospitals. The mean Flesch-Reading Ease score was 61.2 ± 11.9. Fifty-two percent (n = 16) of patient education materials had Flesch-Reading Ease scores above the recommended score of 65. The average reading grade level was 10.5 ± 2.1. The average total DISCERN score was 43.6 ± 10.1. Only 26% of patient education materials (PEMs) had DISCERN scores corresponding to a "good quality" rating. There was a significant positive correlation between DISCERN scores and both Flesch-Reading Ease scores and average reading grade level.

Conclusions

The majority of patient education materials were written above the recommended sixth-grade reading level and the quality of online information pertaining to neck dissections was found to be suboptimal. This research highlights the need for patient education materials regarding neck dissection that are high quality and easily understandable by patients.

Sex and Love Among Older Adults in the Digital World: A Scoping Review

BACKGROUND AND OBJECTIVES

The digital world offers opportunities for sex and love and also reflects societal stereotypes regarding sex and love among older adults. The aim of the current review is to look at the ways older adults use digital media for sex and love and also at digital media's representations of older adults.

RESEARCH DESIGN AND METHODS

We searched for studies published in English that used qualitative and/or quantitative methods, with findings based on empirical data from individuals 55 years of age or older. The following data sets were searched: PubMed, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, and CINAHL. Bibliographies of all relevant studies were searched. Titles and abstracts were reviewed, and selected articles were extracted independently by 2 reviewers.

RESULTS

A total of 1,819 records were retrieved. After removing duplicates, 1,488 records remained. Of these, 70 records remained for full-text screening, and a final count of 15 records was included for synthesis.

DISCUSSION AND IMPLICATIONS

The present review highlights major research gaps in the field. Although studies have indeed focused on the online dating scene among this cohort, they have ignored older adults' sexuality in favor of other aspects (e.g., love and companionship). Representations of this cohort in terms of love and sex are also lacking, and diversity is hardly addressed. Additional research is needed to examine how older adults use digital media for reasons related to love and sex, and how the media mirrors societal stereotypes regarding sex and love among older adults.

The quality and reliability analysis of YouTube videos about insulin resistance

AIM

There is an increasing trend in the use of internet as a search tool for health-related informations. Insulin resistance is one of the most searched subjects online and some of the videos about insulin resistance have been watched by millions of YouTube users. This study aims to determine the quality and reliability of the most popular videos about insulin resistance on YouTube.

METHODS

On March 1, 2022, the term "insulin resistance" was searched on YouTube. The videos' popularity was assessed with Video Power Index (VPI). The quality and reliability were assessed with DISCERN score, modified DISCERN score and global quality score (GQS).

RESULTS

A total of 100 most popular videos were evaluated after applying the exclusion criteria. Fifty-four percent of the videos were very poor-poor, 35 % moderate, and 11 % good-excellent quality. Although few in number, the videos with relatively higher quality and more reliable had higher numbers of views, likes and comments (p < 0.01). There was a positive correlation between DISCERN score and VPI, duration, view, like, dislike, comment numbers of the videos (p < 0.01). Healthcare providers uploaded 58 % of the videos, while independent users uploaded 42 %. Video like ratio (VLR) at healthcare providers' videos was significantly higher than independent users' videos (p = 0.001).

CONCLUSIONS

Despite the high viewing rates of YouTube videos about insulin resistance, the overall quality and reliability were found to be very low. However, when high quality content regarding popular medical topics is produced, more people can be informed correctly.

Analysis of the quality and reliability of trifocal intraocular lens videos on YouTube

OBJECTIVE

This study analyzed the quality and reliability of videos on YouTube as educational resources on trifocal intraocular lenses (IOL).

METHODS

This study is a retrospective, cross-sectional and record-based study. An online YouTube search was performed using the terms "trifocal lens implants" and "trifocal IOL," and a total of 229 videos were recorded. Eighty-six videos that met the study criteria were included. All videos were evaluated with DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Score (GQS) scores.

RESULTS

The mean DISCERN, JAMA, and GQS scores were 37.79±11.92, 2.01±0.87, and 2.17±1.01, respectively. Of all the videos, 39 (45%) were uploaded by physicians, and 47 (55%) were uploaded by non-physicians. While the length of the videos (length) was significantly greater in the physician group (P=0.02), the age of the videos (age) was significantly higher in the non-physician group (P=0.02). However, the differences between the two groups in terms of other general characteristics, DISCERN, JAMA and GQS scores were not significant.

CONCLUSIONS

Our finding suggests that trifocal IOL-related YouTube™ videos are of low quality and reliability, thus inadequate for patient information.

Quality of YouTube Videos Related to Colorectal Cancer Screening

Introduction YouTube, an unregulated video-sharing website, is the second most visited website on the internet. As more patients turn to the internet for information about colon cancer screening, it is important to understand what they are consuming online. Our goal was to evaluate YouTube videos about colon cancer screening to better understand the information patients are accessing. Methods We searched YouTube on October 28, 2020, using the following search terms sorted by relevance and view count: colonoscopy, colon cancer screening, virtual colonoscopy, colonoscopy alternatives, and cologuard. Videos longer than 10 minutes, not in English, and duplicates were excluded. Three evaluators graded each video using the DISCERN criteria. Numerical data were averaged into a composite score. Two-sided t-tests and one-way ANOVA tests were used to compare mean ratings between groups. Results Fifty videos were analyzed, with a total of 23,148,938 views, averaging 462,979 views per video. The average overall rating was 3.16/5. There was no difference between search methods, search terms, or presence of a physician. The average ratings for videos with gastroenterologists (3.08), other physicians (3.35), and non-physicians (3.09) were not significantly different. Videos without physicians had more views on average (1,148,677) compared to videos with gastroenterologists (157,846, p=0.013) or other physicians (35,730, p=0.013). Conclusion YouTube videos related to colon cancer screening were of good quality regardless of search terms, search methods, or presence of a physician. However, videos without physicians were viewed more frequently. Physicians should continue making videos that address deficits while increasing viewership.