How to survive the medical misinformation mess

Evaluating AI-generated patient education materials for spinal surgeries: Comparative analysis of readability and DISCERN quality across ChatGPT and deepseek models

BACKGROUND

Access to patient-centered health information is essential for informed decision-making. However, online medical resources vary in quality and often fail to accommodate differing degrees of health literacy. This issue is particularly evident in surgical contexts, where complex terminology obstructs patient comprehension. With the increasing reliance on AI models for supplementary medical information, the reliability and readability of AI-generated content require thorough evaluation.

OBJECTIVE

This study aimed to evaluate four natural language processing models-ChatGPT-4o, ChatGPT-o3 mini, DeepSeek-V3, and DeepSeek-R1-in generating patient education materials for three common spinal surgeries: lumbar discectomy, spinal fusion, and decompressive laminectomy. Information quality was evaluated using the DISCERN score, and readability was assessed through Flesch-Kincaid indices.

RESULTS

DeepSeek-R1 produced the most readable responses, with Flesch-Kincaid Grade Level (FKGL) scores ranging from 7.2 to 9.0, succeeded by ChatGPT-4o. In contrast, ChatGPT-o3 exhibited the lowest readability (FKGL > 10.4). The DISCERN scores for all AI models were below 60, classifying the information quality as "fair," primarily due to insufficient cited references.

CONCLUSION

All models achieved merely a "fair" quality rating, underscoring the necessity for improvements in citation practices, and personalization. Nonetheless, DeepSeek-R1 and ChatGPT-4o generated more readable surgical information than ChatGPT-o3. Given that enhanced readability can improve patient engagement, reduce anxiety, and contribute to better surgical outcomes, these two models should be prioritized for assisting patients in the clinical.

LIMITATION & FUTURE DIRECTION

This study is limited by the rapid evolution of AI models, its exclusive focus on spinal surgery education, and the absence of real-world patient feedback, which may affect the generalizability and long-term applicability of the findings. Future research ought to explore interactive, multimodal approaches and incorporate patient feedback to ensure that AI-generated health information is accurate, accessible, and facilitates informed healthcare decisions.

Role of information sources in adherence to COVID-19-related safety measures among college students in the USA

OBJECTIVE

During the COVID-19 pandemic, information sources such as public officials, national/international media, social media, public health agencies, college/university officials, etc., played a vital role in adherence to safety measures, including hygiene practices, social distancing, and mask-wearing. We analyze the role of trusted sources of information in adherence to safety measures and explore potential disparities among US college students during the pandemic.

METHODS

We analyze Healthy Minds Study (HMS) 2020-2021 COVID Module data and utilize multivariable logistic regressions controlling for sociodemographic and COVID-19-related factors. Subgroup analyses were conducted by gender, citizenship status, race, and educational level.

RESULTS

Significant differences were found in adherence to safety measures when information was received from different sources. Demographic subgroups within the college student population depended on different sources of COVID-19-related information. Adherence to COVID-19-related safety measures also differed by demographic characteristics.

CONCLUSION

This analysis supports the necessity for targeted health-related messaging among US college students.

Health information quality of online newspaper articles in Korea

BACKGROUND

The Web is an important source of health information, but the quality of such online information is highly variable. This study evaluates the quality of health articles published on Naver News, Korea's most popular portal, using the Health Information Quality Assessment Tool (HIQUAL).

METHODS

We collected 712 health-related articles published on Naver News from May 1 to 7, 2023. After applying exclusion criteria, we selected 116 articles for analysis. Two clinicians independently assessed the quality of these articles using the HIQUAL, which scores articles based on five domains: "reliability," "usefulness," "understandability," "sufficiency," and "transparency."

RESULTS

Overall article quality was generally considered recommendable (mean±standard deviation: 7.52±2.00). "Usefulness," one item of "reliability," and "understandability" were the three items with the highest levels of satisfaction. "Sufficiency" criteria for costs, risks, and benefits received low scores. Quality scores for articles focused on health risk factors and intervention showed a statistically significant difference.

CONCLUSION

While the overall quality of health information in Korean online newspaper articles is acceptable, room for improvement remains in some areas, particularly with regard to the fair presentation of costs, risks, and benefits. The study highlights the need for ongoing quality improvement and evaluation initiatives for online health information.

Transparency, trustworthiness and usefulness in pre-eclampsia randomised controlled trials in the last three decades

OBJECTIVES

Over the last decades, there has been a rising number of randomised controlled trials (RCTs) on pre-eclampsia. We investigated pre-eclampsia RCTs between 1987 and 2021 and reported on trustworthiness, risk of biases, p-values, transparency, and usefulness.

METHODS

We searched PubMed for RCTs containing "pre-eclampsia" or "hypertensive disorders of pregnancy" in the title between 1987 and 2021. We created a transparency, trustworthiness and usefulness checklist, and recorded the characteristics of p-value reporting, RCT characteristics including registration, journal of publication, and outcomes.

RESULTS

We found 202 RCTs, with the median number of authors increasing from four in 1987 to 12 in 2021. Trial registration increased nearly seven-fold from 17/93 between 1987-2010 to 79/109 RCTs registered between 2011-2021. Between 2010-2021, 338 p-values were published in the abstract with a rise in non-significant p-values (significant vs non-significant: 214/338, 63% vs 124/338, 37%). The number of effect sizes published increased by 58% from 659 in 1987-2010 to 1,038 in 2011-2021. The median of combined transparency and usefulness scores of RCTs improved from 6 to 9 out of 13, between 1987-1991 and 2017-2021. From the trustworthiness checklist, trials performed worst at adequate registration (43/202, 21%). Risk of reporting, performance, and detection biases were detected in most RCTs (166/202, 82%, 131/202, 65% and 141/202, 70% respectively).

CONCLUSION

The reporting of non-significant p-values and effect sizes increased after mandatory trial registration in 2010, along with the transparency and trustworthiness of most trials. RCTs need to be more transparent, trustworthy, and useful to increase the value of research.

A Performance Evaluation of Large Language Models in Keratoconus: A Comparative Study of ChatGPT-3.5, ChatGPT-4.0, Gemini, Copilot, Chatsonic, and Perplexity

Background: This study evaluates the ability of six popular chatbots; ChatGPT-3.5, ChatGPT-4.0, Gemini, Copilot, Chatsonic, and Perplexity, to provide reliable answers to questions concerning keratoconus. Methods: Chatbots responses were assessed using mDISCERN (range: 15-75) and Global Quality Score (GQS) (range: 1-5) metrics. Readability was evaluated using nine validated readability assessments. We also addressed the quality and accountability of websites from which the questions originated. Results: We analyzed 20 websites, 65% "Private practice or independent user" and 35% "Official patient education materials". The mean JAMA benchmark score was 1.40 ± 0.91 (0-4 points), indicating low accountability. Reliability, measured using mDISCERN, ranged from 42.91 ± 3.15 (ChatGPT-3.5) to 46.95 ± 3.53 (Copilot). The most frequent question was "What is keratoconus?" with 70% of websites providing relevant information. This received the highest mDISCERN score (49.30 ± 4.91) and a relatively high GQS score (3.40 ± 0.56) with an Automated Readability Level Calculator score of 13.17 ± 2.13. Moderate positive correlations were determined between the website numbers and both mDISCERN (r = 0.265, p = 0.25) and GQS (r = 0.453, p = 0.05) scores. The quality of information, assessed using the GQS, ranged from 3.02 ± 0.55 (ChatGPT-3.5) to 3.31 ± 0.64 (Gemini) (p = 0.34). The differences between the texts were statistically significant. Gemini emerged as the easiest to read, while ChatGPT-3.5 and Perplexity were the most difficult. Based on mDISCERN scores, Gemini and Copilot exhibited the highest percentage of responses in the "good" range (51-62 points). For the GQS, the Gemini model exhibited the highest percentage of responses in the "good" quality range with 40% of its responses scoring 4-5. Conclusions: While all chatbots performed well, Gemini and Copilot showed better reliability and quality. However, their readability often exceeded recommended levels. Continuous improvements are essential to match information with patients' health literacy for effective use in ophthalmology.

Major mistakes or errors in the use of trial sequential analysis in systematic reviews or meta-analyses - the METSA systematic review

BACKGROUND

Systematic reviews and data synthesis of randomised clinical trials play a crucial role in clinical practice, research, and health policy. Trial sequential analysis can be used in systematic reviews to control type I and type II errors, but methodological errors including lack of protocols and transparency are cause for concern. We assessed the reporting of trial sequential analysis.

METHODS

We searched Medline and the Cochrane Database of Systematic Reviews from 1 January 2018 to 31 December 2021 for systematic reviews and meta-analysis reports that include a trial sequential analysis. Only studies with at least two randomised clinical trials analysed in a forest plot and a trial sequential analysis were included. Two independent investigators assessed the studies. We evaluated protocolisation, reporting, and interpretation of the analyses, including their effect on any GRADE evaluation of imprecision.

RESULTS

We included 270 systematic reviews and 274 meta-analysis reports and extracted data from 624 trial sequential analyses. Only 134/270 (50%) systematic reviews planned the trial sequential analysis in the protocol. For analyses on dichotomous outcomes, the proportion of events in the control group was missing in 181/439 (41%), relative risk reduction in 105/439 (24%), alpha in 30/439 (7%), beta in 128/439 (29%), and heterogeneity in 232/439 (53%). For analyses on continuous outcomes, the minimally relevant difference was missing in 125/185 (68%), variance (or standard deviation) in 144/185 (78%), alpha in 23/185 (12%), beta in 63/185 (34%), and heterogeneity in 105/185 (57%). Graphical illustration of the trial sequential analysis was present in 93% of the analyses, however, the Z-curve was wrongly displayed in 135/624 (22%) and 227/624 (36%) did not include futility boundaries. The overall transparency of all 624 analyses was very poor in 236 (38%) and poor in 173 (28%).

CONCLUSIONS

The majority of trial sequential analyses are not transparent when preparing or presenting the required parameters, partly due to missing or poorly conducted protocols. This hampers interpretation, reproducibility, and validity.

STUDY REGISTRATION

PROSPERO CRD42021273811.

Understanding medical students' transition to and development in clerkship education: a qualitative study using grounded theory

BACKGROUND

Medical students perceive the transition to clerkship education as stressful and challenging and view themselves as novices during their rotation in clerkship education. The developmental perspective is thus important because the transition to clerkship supports rather than hinders growth. Accordingly, this study examines medical students' transition to clerkship and their developmental features.

METHODS

In-depth interviews were conducted with 18 medical students or graduates who had completed clerkships as medical students. Based on Straussian grounded theory, the collected data were analyzed in terms of the differences between pre- and post-clerkship education.

RESULTS

Our data analysis revealed five stages of the transition process: "anticipation and anxiety," "reality check," "seeking solutions," "practical application," and "transition and stability." The core category, that is, "growing up from being students to being student doctors," was driven by patients who perceived the participants as student doctors. Meanwhile, the participants recognized that having a solution that is agreed upon by colleagues was more important than knowing the correct answer. The participants undergoing the transition to clerkship showed developmental features divided into three categories: personal, social, and professional. Specifically, they attempted to balance clerkship and life through personal development, learned to navigate around the hospital and reduced tension through social development, and developed clinical competencies focused on efficiency through professional development.

CONCLUSIONS

This study explores the process of students' transition to clerkship education and the developmental features that emerge during this period. The students were motivated by patients who perceived them as student doctors. Through the transition, they maintained a work-life balance and adapted to hospitals but developed an overly doctor-centered attitude by cultivating clinical competencies with a focus on efficiency. To develop them into medical professionals, it is essential to assist their transition and cultivate a patient-centered attitude.

A Network Enhancement Method to Identify Spurious Drug-Drug Interactions

As medical safety and drug regulation gain heightened attention, the detection of spurious drug-drug interactions (DDI) has become key in healthcare. Although current research using graph neural networks (GNNs) to predict DDI has shown impressive results, it often fails to account for false DDI in the constructed DDI networks. Such inaccuracies caused by data errors, false alarms, or incorrect drug details can skew the network's structure and hinder the accuracy of GNN-based predictions. To tackle this challenge, we propose ANSM, a network-enhancement method specifically designed to identify and attenuate spurious links between drugs for ensuring the accuracy of DDI networks. ANSM integrates three key components: the feature extractor, the network optimizer, and the discriminative classifier. The feature extractor captures local structural features from drug node pairs, while the network optimizer leverages network information to improve feature extraction and reduce the impact of spurious DDI links. The discriminative classifier then identifies potential spurious links. Experimental results demonstrate that ANSM outperforms state-of-the-art methods in identifying spurious DDI.

An analysis of oral contraceptive related videos on TikTok

Background

TikTok has increasingly become a source of information about reproductive health. Patients seeking health information about oral contraception on TikTok may be influenced by videos containing misinformation or biased information.

Objective

This social media infodemiological study aims to provide a descriptive content analysis of the quality and reliability of oral contraceptive health information on TikTok.

Study Design

Researchers screened 1,000 TikTok videos from December 2022 to March 2023 retrieved under various search terms related to oral contraceptives. Data, including engagement metrics such as views, likes, comments, saves, and shares, were recorded. Video content including contraceptive methods discussed, efficacy, tolerability, and side effects were recorded. Two reviewers independently used a modified DISCERN criteria and Global Quality Scale (GQS) to assess the quality and reliability of information for each video.

Results

Five hundred seventy-four videos were analyzed after applying exclusion criteria. Videos had a median length of 27 seconds (Q1=13sec, Q3=57sec) and received a median of 35,000 total views (Q1=4856 views, Q3=411,400 views) and 166 views per day (Q1=28 views per day, Q3=2021 views per day). Video creators were 83.3% female and 58.7% white. The mean modified DISCERN score was 1.63 (SD=1.06) and the mean GQS score was 2.28 (SD=1.37). Video creators were 83.3% female and 58.7% white. The mean modified DISCERN score was 1.63 (SD=1.06) and the mean GQS score was 2.28 (SD=1.37). The most common topic discussed in the videos was the effects of contraception. Healthcare professionals had significantly higher DISCERN and GQS scores (p<.001) than non-healthcare professionals. However, they received fewer views, likes, and comments on their videos (p<.001). Healthcare professionals were 86 times more likely than non-healthcare professionals to post educational videos (p<.001). However, non-educational content received significantly more views, likes, and comments than educational content (p<.001).

Conclusion

TikTok videos related to oral contraceptive health had low quality and reliability of information. The majority of videos were made by non-healthcare providers, and the most common topic discussed was the effects of contraception. Videos made by healthcare professionals contained more reliable contraceptive information, but received less engagement than videos made by non-healthcare professionals. Healthcare providers should consider the prevalence of poor-quality information about oral contraceptives on social media when counseling and educating patients about reproductive health.

Interpretation and use of a decision support tool for multiple treatment options: a combined randomised controlled trial and survey of medical students

OBJECTIVES

To investigate medical students' ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence summaries for multiple treatment options (Making Alternative Treatment CHoices Intuitive and Trustworthy, MATCH-IT).

DESIGN

A combined randomised controlled trial and survey. Participants were presented with a clinical scenario and randomised to one of two versions of the MATCH-IT tool (A/B), instructed to explore the evidence and decide on a recommendation. Participants answered a questionnaire assessing interpretation, treatment recommendation self-assessed understandability and perceived usefulness before exposure to the other MATCH-IT version and asked questions on design preferences.

SETTING

Online lecture in an evidence-based medicine (EBM) introductory course.

PARTICIPANTS

149 third-year medical students. 52% (n=77) had 6 months of clinical training and 48% (n=72) had preclinical training only.

INTERVENTIONS

The MATCH-IT tool version A uses colour coding to categorise interventions by magnitude and direction of effects and displays all outcomes in a table on entry. Version B has no colour coding, and the user must decide which outcomes to display in the table.

MAIN OUTCOME MEASURES

Interpretation of evidence, treatment recommendation, perceived usefulness and understandability, preference for format and design alternatives.

RESULTS

82.5% (n=123) of medical students correctly answered ≥4 out of 5 multiple choice questions assessing interpretation of data. 75.8% (n=114) of students made a treatment recommendation in accordance with an expert panel for the same clinical scenario. 87.2% (n=130) found the tool understandable while 91.9% perceived the tool as useful in addressing the clinical scenario.

CONCLUSION

Medical students with no prior training in EBM can interpret and use the MATCH-IT tool. Certain design alternatives were preferred but had no bearing on interpretation of evidence or understandability of the tool.

Harnessing Reliable Evidence in the Post-COVID Era: A Practice Guide to Navigating the Ocean of Medical Literature

The reliability and relevance of medical literature are significant concerns in the post-COVID-19 era, where misinformation and disinformation are serious threats. This practice guide provides an overview of practical strategies to appraise the reliability of research publications critically. These strategies include critically appraising the effectiveness and constraints of various approaches to disseminating medical information, choosing appropriate medical literature resources, navigating library databases, screening the literature from the search, and screening individual publications. We also discuss the importance of considering study limitations and the relevance of the results in research or use in the medical arena. In-depth, critical appraisal of medical or clinical research evidence requires expertise, insight into research methodologies, and a grasp of issues in each field. By harnessing the wealth of reliable and relevant information available in medical literature through the above steps, we can alleviate potentially misleading information and stay at the forefront of our respective fields.

'Low-value' clinical care in general practice: a cross-sectional analysis of low-value care in early-career GPs' practice

Nonevidence-based and 'low-value' clinical care and medical services are 'questionable' clinical activities that are more likely to cause harm than good or whose benefit is disproportionately low compared with their cost. This study sought to establish general practitioner (GP), patient, practice, and in-consultation associations of an index of key nonevidence-based or low-value 'questionable' clinical practices. The study was nested in the Registrar Clinical Encounters in Training study-an ongoing (from 2010) cohort study in which Australian GP registrars (specialist GP trainees) record details of their in-consultation clinical and educational practice 6-monthly. The outcome factor in analyses, performed on Registrar Clinical Encounters in Training data from 2010 to 2020, was the score on the QUestionable In-Training Clinical Activities Index (QUIT-CAI), which incorporates recommendations of the Australian Choosing Wisely campaign. A cross-sectional analysis used negative binomial regression (with the model including an offset for the number of times the registrar was at risk of performing a questionable activity) to establish associations of QUIT-CAI scores. A total of 3206 individual registrars (response rate 89.9%) recorded 406 812 problems/diagnoses where they were at risk of performing a questionable activity. Of these problems/diagnoses, 15 560 (3.8%) involved questionable activities being performed. In multivariable analyses, higher QUIT-CAI scores (more questionable activities) were significantly associated with earlier registrar training terms: incidence rate ratios (IRRs) of 0.91 [95% confidence interval (CI) 0.87, 0.95] and 0.85 (95% CI 0.80, 0.90) for Term 2 and Term 3, respectively, compared to Term 1. Other significant associations of higher scores included the patient being new to the registrar (IRR 1.27; 95% CI 1.12, 1.45), the patient being of non-English-speaking background (IRR 1.24; 95% CI 1.04, 1.47), the practice being in a higher socioeconomic area decile (IRR 1.01; 95% CI 1.00, 1.02), small practice size (IRR 1.05; 95% CI 1.00, 1.10), shorter consultation duration (IRR 0.99 per minute; 95% CI 0.99, 1.00), and fewer problems addressed in the consultation (IRR 0.84; 95% CI 0.79, 0.89) for each additional problem]. Senior registrars' clinical practice entailed less 'questionable' clinical actions than junior registrars' practice. The association of lower QUIT-CAI scores with a measure of greater continuity of care (the patient not being new to the registrar) suggests that continuity should be supported and facilitated during GP training (and in established GPs' practice).

The Application of Evidence-Based Medicine in Individualized Medicine

The fundamental aim of healthcare is to improve overall health of the population by providing state-of-the-art healthcare for individuals at an affordable cost. The foundation for this system is largely referred to as "evidence-based medicine". Too often, evidence-based medicine is based solely on so-called "best research evidence", collected through randomized controlled trials while disregarding clinical expertise and patient expectations. As healthcare gravitates towards personalized and individualized medicine, such external clinical (research) evidence can inform, but never replace, individual clinical expertise. This applies in particular to orphan diseases, for which clinical trials are methodologically particularly problematic, and evidence derived from them is often questionable. Evidence-based medicine constitutes a complex process to allow doctors and patients to select the best possible solutions for each individual based on rapidly developing new therapeutic directions. This requires a revisit of the foundations of evidence-based medicine. A proposition as to how to manage evidence-based data in individualized immune-oncology is presented here.

Open access publishing - noble intention, flawed reality

For two decades, the international scholarly publishing community has been embroiled in a divisive debate about the best model for funding the dissemination of scientific research. Some may assume that this debate has been thoroughly resolved in favour of the Open Access (OA) model of scientific publishing. Recent commentaries reveal a less settled reality. This narrative review aims to lay out the nature of these deep divisions among the sector's stakeholders, reflects on their systemic drivers and considers the future prospects for actualising OA's intended benefits and surmounting its risks and costs. In the process, we highlight some of inequities OA presents for junior or unfunded researchers, and academics from resource-poor environments, for whom an increasing body of evidence shows clear evidence of discrimination and injustice caused by Article Processing Charges. The authors are university-appointed researchers working the UK and South Africa, trained in disciplines ranging from medicine and epidemiology to social science and digital science. We have no vested interest in any particular model of scientific publication, and no conflicts of interest to declare. We believe the issues we identify are pertinent to almost all research disciplines.

Publication trends and usefulness of research in hysteroscopic myomectomy for heavy menstrual bleeding: A review of the published literature

Despite the amount of research into hysteroscopic myomectomy, questions about the optimal treatment of heavy menstrual bleeding remain. This study reviewed publication trends on this topic from 2002 to 2019 and assessed the usefulness of studies. A total of 580 articles were published on PubMed in this time frame, in 15 different languages. There were meta-analyses (1.6%), systematic reviews (12%), and randomized controlled trials (4.2%). Twelve percent were published in high impact factor journals. After applying our selection criteria, the usefulness of 37 articles was assessed: one article scored high, 31 scored moderate, and five scored low. The costs of these studies were estimated at US$ 971 700.

Radiation Exposure Among Orthopaedic Trauma Surgeons: Deconstructing Commonly Held Myths and Misperceptions

OBJECTIVES

To review and evaluate the validity of common perceptions and practices regarding radiation safety in orthopaedic trauma.

DESIGN

Retrospective study.

SETTING

Level 1 trauma center.

SUBJECTS

N/A.

INTERVENTION

The intervention involved personal protective equipment.

MAIN OUTCOME MEASUREMENTS

The main outcome measurements included radiation dose estimates.

RESULTS

Surgeon radiation exposure estimates performed at the level of the thyroid, chest, and pelvis demonstrate an estimated total annual exposure of 1521 mR, 2452 mR, and 1129 mR, respectively. In all cases, wearing lead provides a significant reduction (90% or better) in the amount of radiation exposure (in both radiation risk and levels of radiation reaching the body) received by the surgeon. Surgeons are inadequately protected from radiation exposure with noncircumferential lead. The commonly accepted notion that there is negligible exposure when standing greater than 6 feet from the radiation source is misleading, particularly when cumulative exposure is considered. Finally, we demonstrated that trauma surgeons specializing in pelvis and acetabular fracture care are at an increased risk of exposure to potentially dangerous levels of radiation, given the amount of radiation required for their caseload.

CONCLUSION

Common myths and misperceptions regarding radiation in orthopaedic trauma are unfounded. Proper use of circumferential personal protective equipment is critical in preventing excess radiation exposure.

Experiences of women undergoing infertility treatment from embryo transfer until pregnancy test and their conceptualization of their embryo

AIM

This study aims to explore women's experiences with embryo transfer (ET) until pregnancy test and their conceptualization of their embryo.

METHOD

The sample of this descriptive phenomenology study consists of 17 women with ET. The data were collected through in-depth interviews. The thematic analysis developed by Braun and Clarke was used for data analysis.

RESULTS

Analysis of the interviews led to the emergence of five themes and 14 sub-themes. The theme "pregnancy in biological terms" has two sub-themes: "considering herself pregnant" and "the first moment with the baby". The theme "not an embryo, my child" has three sub-themes: "world of hope", " unnatural but normal" and "attachment to embryo". The theme "daily life after ET" has three sub-themes: "living life in the usual way", "process of self-listening", and "the negative effects of drugs on the body". The theme "seeking ways to ensure fertility" has four sub-themes: "complete bed rest", "the search for information: the internet", "practice an infertility diet" and "spiritual support with prayer". Finally, the theme "caring after the transfer" has two sub-themes: "need more information" and "unmet women-oriented care".

CONCLUSION

In this study, it was determined that women had intense physical and emotional experiences during the waiting period after ET and their daily lives were affected. It was also understood that the embryo means "baby/child/son/daughter" to them and that they establish a close bond with their embryos. Women's needs are not sufficiently known until post-ET pregnancy testing. Explaining the experiences of women after IVF-ET and the meanings of their embryo will help determine the issues they need in holistic care.

'Low-value' clinical care in general practice: associations of low value care in GP trainees' practice, including formative and summative examination performance - protocol for cross-sectional and retrospective cohort study analyses using the QUestionable In Training Clinical Activities (QUIT-CA) index

INTRODUCTION

'Low value' clinical care and overuse of medical services are 'questionable' clinical activities that entail provision of medical services that are more likely to cause harm than good or whose benefit is disproportionately low compared with its cost. This study will seek to establish clinical practice associations of a non-observed work-based assessment of general practitioner (GP) trainees' (registrars') questionable practice (the QUestionable In Training Clinical Activities (QUIT-CA) index). We will also explore association of the QUIT-CA index with a formative observed work-based assessment, and will establish if registrars' QUIT-CA indexes are associated with summative examination performance.

METHODS AND ANALYSIS

We will conduct three analyses, all using data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing (from 2010) cohort study in which Australian GP registrars record details of their in-consultation clinical and educational practice. The QUIT-CA index is compiled from ReCEnT consultation data. A cross-sectional analysis, using negative binomial regression, will establish clinical practice associations of the QUIT-CA index. A cross-sectional analysis using linear regression will be used to establish associations of QUIT-CA index with formative observed in-practice assessment (the General Practice Registrar-Competency Assessment Grid). A retrospective cohort study analysis using linear regression will be used to establish associations of the QUIT-CA index with summative examination performance (Royal Australian College of General Practice fellowship examinations results).

ETHICS AND DISSEMINATION

The study has ethical approval from the University of Newcastle HREC(H-2009-0323). Findings will be disseminated in peer-reviewed journal articles and conference presentations.

Broad Medical Uncertainty and the ethical obligation for openness

This paper argues that there exists a collective epistemic state of 'Broad Medical Uncertainty' (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a 'Corrective Response'. We then consider some objections to this position (the 'Anti-Corrective Response'), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing.

Addressing health communication in the era of alternative truths: the view from medical assistance

The negative impact of medical misinformation on travellers in a multinational organizational context is substantial. A clear framework for assessing and reducing the risk of inaccurate health information is required in the current rapidly changing travel context, especially to locations where the healthcare system is unfamiliar.

A scoping review to map the evidence of physical activity interventions in post-treatment adolescent and young adult cancer survivors

PURPOSE

This scoping review describes and synthesizes previously reported data to document physical activity (PA) interventions in adolescents and young adult (AYA) cancer survivors and to explore whether PA interventions tested to date improve survivors' health outcomes.

METHODS

A search of the literature was conducted in PubMed, CINAHL, EMBASE, Web of Science and Cochrane Library following the PRISMA-ScR statement. We included all original studies (n = 8) investigating PA interventions in AYA cancer survivors.

RESULTS

This review showed that PA interventions were feasible and acceptable in AYA cancer survivors. PA interventions were individualized and mainly aerobic in nature. Studies examining the effects of PA interventions on survivors' health evaluated physical and mental health outcomes.

CONCLUSIONS

Our scoping review maps the current evidence of PA interventions and highlights the paucity of data in this area of investigation, obviating how much work remains to be done to demonstrate the potential benefits of PA on AYA cancer survivors' health outcomes.

Dispelling Covid-19 Misinformation

At the writing of this article at the start of November 2021, 247,416,351 persons have died of COVID-19 worldwide and 46,815,210 have died in the United States.¹ Along with the tragic loss has come an infodemic-the widespread of misinformation in social media and published literature. Infodemiology is the study of analyzing the relationship between channels of health information demands and health information supply. Healthcare providers have an important role to quash this misinformation at all information access points. Hospital Librarians and other health information professionals also have a role to play to work with other health professionals, to dispel this misinformation. This article speaks to those two subjects and highlights Dear Pandemic.org and "Those Nerdy Girls."

Beyond belief: a cross-genre study on perception and validation of health information online

Natural language undergoes significant transformation from the domain of specialized research to general news intended for wider consumption. This transition makes the information vulnerable to misinterpretation, misrepresentation, and incorrect attribution, all of which may be difficult to identify without adequate domain knowledge and may exist even in the presence of explicit citations. Moreover, newswire articles seldom provide a precise correspondence between a specific claim and its origin, making it harder to identify which claims, if any, reflect the original findings. For instance, an article stating "Flagellin shows therapeutic potential with H3N2, known as Aussie Flu." contains two claims ("Flagellin ... H3N2," and "H3N2, known as Aussie Flu") that may be true or false independent of each other, and it is prima facie unclear which claims, if any, are supported by the cited research. We build a dataset of sentences from medical news along with the sources from peer-reviewed medical research journals they cite. We use these data to study what a general reader perceives to be true, and how to verify the scientific source of claims. Unlike existing datasets, this captures the metamorphosis of information across two genres with disparate readership and vastly different vocabularies and presents the first empirical study of health-related fact-checking across them.

A machine learning application for raising WASH awareness in the times of COVID-19 pandemic

The COVID-19 pandemic has revealed the power of internet disinformation in influencing global health. The deluge of information travels faster than the epidemic itself and is a threat to the health of millions across the globe. Health apps need to leverage machine learning for delivering the right information while constantly learning misinformation trends and deliver these effectively in vernacular languages in order to combat the infodemic at the grassroot levels in the general public. Our application, WashKaro, is a multi-pronged intervention that uses conversational Artificial Intelligence (AI), machine translation, and natural language processing to combat misinformation (NLP). WashKaro uses AI to provide accurate information matched against WHO recommendations and delivered in an understandable format in local languages. The primary aim of this study was to assess the use of neural models for text summarization and machine learning for delivering WHO matched COVID-19 information to mitigate the misinfodemic. The secondary aim of this study was to develop a symptom assessment tool and segmentation insights for improving the delivery of information. A total of 5026 people downloaded the app during the study window; among those, 1545 were actively engaged users. Our study shows that 3.4 times more females engaged with the App in Hindi as compared to males, the relevance of AI-filtered news content doubled within 45 days of continuous machine learning, and the prudence of integrated AI chatbot "Satya" increased thus proving the usefulness of a mHealth platform to mitigate health misinformation. We conclude that a machine learning application delivering bite-sized vernacular audios and conversational AI is a practical approach to mitigate health misinformation.

Successes, lessons and opportunities: 15-year follow-up of an integrated evidence-based medicine curriculum

In 2005, the Department of Family Medicine at the University of Alberta introduced an evidence-based practice curriculum into the 2-year Family Medicine Residency Program. The curriculum was based on best available evidence, had multiple components and was comprehensive in its approach. It prioritised preappraised summary evidence over in-depth evidence appraisal. This paper describes the lessons learnt over the past 15 years including components that were eventually discontinued. We also discuss additions to the programme including the development of accessible, preappraised, summarised resources. We review the difficulties associated with evaluation and the incorporation of evidence-based practice into all aspects of residency training. Future directions are discussed including the incorporation of shared decision-making at the point of care.

They promised this ten years ago. Effects of diabetes news characteristics on patients' perceptions and attitudes towards medical innovations and therapy adherence

Patients have ever-increasing access to web-based news about hopeful scientific developments that may or may not cure them in the future. Science communication experts agree that the quality of news provision is not always guaranteed. However, literature does not clarify in what way users are actually affected by typical news characteristics such as the news object (described developmental phase of an innovation), the news source (degree of authority), and the news style (degree of language intensification). An online vignette experiment (N = 259) investigated causal relationships between characteristics of news about diabetes innovations and patients’ perceptions of future success, their interest in the innovation, and attitudes regarding current therapy adherence. Findings show that descriptions of success in mice led to higher estimations of future success chances than earlier and later developmental phases. Furthermore, news from a nonauthoritative source led to an increased interest in the innovation, and a more negative attitude towards current lifestyle advice. Lastly, the intensification of the language used in news messages showed slight adverse effects on the readers’ attitude. These findings, combined with their small effect sizes, support the optimistic view that diabetes patients are generally critical assessors of health news and that future research on this topic should focus on affected fragile subgroups.

Prospective assessment of a critical appraisal teaching programme on medical students' confidence and performance in appraising medical literature

BACKGROUND

Previous research has demonstrated that medical students have insufficient knowledge of critical appraisal, a fundamental aspect of evidence-based medicine. We aimed to enhance medical students' critical appraisal skills using an innovative mixed-methods programme.

METHODS

We designed a 2-day, mixed-methods, national teaching programme, including an interactive lecture and workshop, quiz and viva-style examination. Course efficacy was assessed using pre- and post-course confidence questionnaires and a quiz adapted from the validated Berlin Questionnaire. Data were analysed primarily using Wilcoxon Signed Ranks test.

RESULTS

Fifty-nine participants from 17 medical schools completed the programme. Pre- and post-course scores demonstrated significant improvement in confidence (median score 5 vs 8; p < 0.001) and quiz performance (median score 9 vs 13; p < 0.001).

CONCLUSION

Our study demonstrates the efficacy of a novel mixed-methods programme in teaching medical students about critical appraisal. Implementation of our approach within the undergraduate curriculum should enhance the uptake of these fundamental skills.

Using variation between countries to estimate demand for Cochrane reviews when access is free: a cost-benefit analysis

OBJECTIVES

Cochrane reviews are currently of limited use as many healthcare professionals and patients have no access to them. Most member states of the Organisation for Economic Co-operation and Development (OECD) choose not to pay for nationwide access to the reviews, possibly uncertain whether there is enough demand to warrant the costs of a national subscription. This study estimates the demand for review downloads and summary views under free access across all OECD countries.

DESIGN

The study employs a retrospective design in analysing observational data of web traffic to Cochrane websites in 2014. Specifically, we model for each country downloads of Cochrane reviews and views of online summaries as a function of free access status and alternative sources of variation across countries. The model is then used to estimate demand if a country with restricted access were to purchase free access. We use these estimates to perform a cost-benefit analysis.

RESULTS

For one group of eight OECD countries, the additional downloads under free access are estimated to cost between US$4 and more than US$20 each. Three countries are expected to save money under free access, as existing institutional subscriptions would no longer be needed. For the largest group of 17 member states, free access is estimated to cost US$0.05-US$2 per additional review download. On average, the increase in review downloads does not appear to be associated with a decrease in the number of summary views. Instead, translations of plain-language summaries into national languages can serve as an additional strategy for dissemination.

CONCLUSIONS

We estimate that free access would cost less than US$2 per additional download for 20 of the 28 OECD countries without national subscriptions, including Canada, Germany and Israel. These countries may be encouraged by our findings to provide free access to their citizens.

Right by your side? - the relational scope of health and wellbeing as congruence, complement and coincidence

Purpose: Although the relation between health and well-being is deemed conceptually important, it is diverse and intractable. The aim of this small-scale study is to reveal different possible relations of the concepts of health and well-being, interrelation of these relations and consequences of implied normative expectations in the relations.

Method: Primary data originate from course literature in Swedish health education. Additional data included scientific articles and website content (collected from WHO and via Google) and were analysed with objective hermeneutics.

Results: Congruent, complementary and coincident relations were found. In congruence, health and well-being are synonyms. Complement relations contain: “quality” with well-being as overall aim, “plurality” with health as umbrella term, “well-being as positive health”, “enhancement” with health and well-being potentially boosting each other and “subjectivity/objectivity” with objective health complemented by subjective well-being. In coincidence, health and well-being are counter-intuitively regarded unlinked, which may challenge expectations concerning health promotive activities. Independent and affiliated relations were identified.

Conclusion: In congruence and complement, health and well-being are mostly aligned whereas in coincidence, their quality may be decoupled. In the discursive climate of second modernity, the relation of health and well-being tends to conflict and ambiguous coincidence, demanding ambiguity tolerance as key skill.

The library's role in countering infodemics

Internet and communication technologies enable the creation of tremendous amounts of textual, graphic, and pictorial information. User-generated content published through personal web pages, blogs, and social media platforms has not only increased the amount of information available, but also expanded its reach. However, this ubiquity of information and empowerment of its creators leads to potentially controversial, futile, and inaccurate content circulating throughout the world. In the case of the COVID-19 pandemic, this can create false hope, fear, anxiety, harm, and confusion amongst information stakeholders. The World Health Organization recently applied the term "infodemic" to the COVID-19 pandemic. This commentary briefly discusses the current infodemic, its potential consequences, and the role of libraries-specifically health sciences, biomedical, and medical libraries-to help counter the COVID-19 infodemic. The discussion also has relevance for infodemics relating to other health and non-health affairs.

A systematic evidence-based review of treatments for primary hyperhidrosis

Objective

Hyperhidrosis (excessive sweating) is associated with significant quality-of-life burden yet is often undertreated. With limited FDA-approved treatments, health care providers must determine optimal treatment among approved and off-label options. Key objectives of this review were to reassess, update, and expand a previous systematic review of commonly used treatment options for primary hyperhidrosis, including consideration of aluminum and zirconium compounds.

Methods

We performed a qualitative systematic review of efficacy, health-related quality of life, satisfaction, and safety of interventions, replicating and expanding the strategy outlined in a previous systematic review, with the addition of studies utilizing a within-patient design. We performed a critical appraisal of identified studies to determine risk of bias (RoB) and strength of evidence (SOE).

Results

A total of 32 studies were eligible for critical appraisal. Only three studies - two clinical trials of glycopyrronium cloth (2.4%) and one trial of botulinum toxin A injections in axillary hyperhidrosis were rated as "low" RoB; both had SOE ratings of "moderate" for use in axillary hyperhidrosis - the highest rating included in this review.

Conclusions

Optimal treatment choice depends on several factors, including understanding the quality of evidence regarding each treatment's efficacy and safety (considerations of convenience and cost are beyond the scope of this review). In hyperhidrosis, as in other clinical conditions, treatment decisions should be patient centered. At this time, because of the quality of evidence, only imprecise estimates of effect are possible for hyperhidrosis treatments included in this review, and statements about comparative effectiveness are not possible.

Determinants of an evidence-based practice environment: an interpretive description

Background

Despite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.

Method

The study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019.

Results

Four determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP.

Conclusion

Introducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.

Reproducible research practices and transparency in reproductive endocrinology and infertility articles

OBJECTIVE

To analyse the published literature in reproductive endocrinology and infertility (REI) to examine the transparency and the use of reproducible research practices of the scientific literature and to identify possible avenues for improvement.

DESIGN

Meta-epidemiologic study. We examined the first 20 consecutive full-text original articles presenting primary data from five REI-specific journals for 2013 and for 2018, and eligible REI articles published in 2013-2018 in five high-impact general journals. Eligible articles were required to be full-text original articles, presenting primary data.

SETTING

Not applicable.

PATIENT(S)

Not applicable.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Each article was assessed for study type, trial registration, protocol and raw data availability, funding and conflict of interest declarations, inclusion in subsequent systematic reviews and/or meta-analyses, sample size, and whether the work claimed to be novel or replication. Sample sizes and citation counts also were obtained.

RESULT(S)

A total of 222 articles were deemed eligible; 98 from REI journals published in 2013, 90 from REI journals published in 2018, and 34 from high-impact journals. There were 37 studies registered, 15 contained a protocol, and two stated actively that they were willing to share data. Most studies provided a statement about funding and conflicts of interest. Two articles explicitly described themselves as replications. All randomized controlled trial published in REI journals were registered prospectively; many meta-analyses were not registered. High-impact journal articles had a greater median sample size and more citations and were more likely to be registered, to have a protocol, and to claim novelty explicitly when compared with REI 2013 and 2018 articles.

CONCLUSION(S)

Research in REI can be improved in prospective registration, routine availability of protocols, wider sharing of raw data whenever feasible, and more emphasis on replication.

Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health

Since 2016, social media companies and news providers have come under pressure to tackle the spread of political mis- and disinformation (MDI) online. However, despite evidence that online health MDI (on the web, on social media, and within mobile apps) also has negative real-world effects, there has been a lack of comparable action by either online service providers or state-sponsored public health bodies. We argue that this is problematic and seek to answer three questions: why has so little been done to control the flow of, and exposure to, health MDI online; how might more robust action be justified; and what specific, newly justified actions are needed to curb the flow of, and exposure to, online health MDI? In answering these questions, we show that four ethical concerns-related to paternalism, autonomy, freedom of speech, and pluralism-are partly responsible for the lack of intervention. We then suggest that these concerns can be overcome by relying on four arguments: (1) education is necessary but insufficient to curb the circulation of health MDI, (2) there is precedent for state control of internet content in other domains, (3) network dynamics adversely affect the spread of accurate health information, and (4) justice is best served by protecting those susceptible to inaccurate health information. These arguments provide a strong case for classifying the quality of the infosphere as a social determinant of health, thus making its protection a public health responsibility. In addition, they offer a strong justification for working to overcome the ethical concerns associated with state-led intervention in the infosphere to protect public health.

Evidence-Based Medicine in Oncology: Commercial Versus Patient Benefit

At times of personalized and individualized medicine the concept of randomized- controlled clinical trials (RCTs) is being questioned. This review article explains principles of evidence-based medicine in oncology and shows an example of how evidence can be generated independently from RCTs. Personalized medicine involves molecular analysis of tumor properties and targeted therapy with small molecule inhibitors. Individualized medicine involves the whole patient (tumor and host) in the context of immunotherapy. The example is called Individualized Multimodal Immunotherapy (IMI). It is based on the individuality of immunological tumor-host interactions and on the concept of immunogenic tumor cell death (ICD) induced by an oncolytic virus. The evidence is generated by systematic data collection and analysis. The outcome is then shared with the scientific and medical community. The priority of big pharma studies is commercial benefit. Methods used to achieve this are described and have damaged the image of RCT studies in general. A critical discussion is recommended between all partners of the medical health system with regard to the conduct of RCTs by big pharma companies. Several clinics and institutions in Europe try to become more independent from pharma industry and to develop their own modern cancer therapeutics. Medical associations should include references to such studies from personalized and individualized medicine in their guidelines.

Nutrition in times of Covid-19, how to trust the deluge of scientific information

PURPOSE OF REVIEW

The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice.

RECENT FINDINGS

A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method.

SUMMARY

It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.

Position paper: new insights into the immunobiology and dynamics of tumor-host interactions require adaptations of clinical studies

INTRODUCTION

Prospective double-blind placebo-controlled randomized clinical trials (RCTs) are considered standard for the proof of the efficacy of oncologic therapies. Molecular methods have provided new insights into tumor biology and led to the development of targeted therapies. Due to the increasing complexity of molecular tumor characteristics and of the individuality of specific anti-tumor immune reactivity, RCTs are unfortunately only of limited use.

AREAS COVERED

The historical methods of drug research and approval and the related practices of reimbursement by statutory and private health insurance companies are being questioned. New, innovative methods for the documentation of evidence in personalized medicine will be addressed. Possible perspectives and new approaches are discussed, in particular with regard to glioblastoma.

EXPERT OPINION

Highly specialized translational oncology groups like the IOZK can contribute to medical progress and quick transfer 'from bench to bedside.' Their contribution should be acknowledged and taken into account more strongly in the development of guidelines and the reimbursement of therapy costs. Methodological plurality should be encouraged.

Relative risks and odds ratios: Simple rules on when and how to use them

AIM

Relative risks and odds ratios are widely reported in the medical literature, but can be very difficult to understand. We sought to further clarify these important indices.

METHODS

We illustrated both relative risks and odds ratios using bar charts, then looked at the types of study for which each statistic is suited. We demonstrated calculation of relative risks and odds ratios through analysis of tabled data from a recent published longitudinal study, using a 2 × 2 table and R, the open-source statistical programming language. Simple rules for when and how to use relative risks and odds ratios are presented.

CONCLUSION

Understanding the difference between relative risks and odds ratios and when and how to use them may aid clinical interpretation, dissemination and translation of research findings.

Improving cancer survivors' e-health literacy via online health communities (OHCs): a social support perspective

PURPOSE

Cancer survivors should have adequate e-health literacy to help them better use online health information. Online health communities (OHCs) can offer cancer survivors different types of social support that can represent another resource to improve health outcomes. However, there is little knowledge of how these OHC are directly related to a cancer survivors' e-health literacy. This study explores how different types of social support in OHCs are associated with cancer survivors' e-health literacy.

METHODS

A questionnaire was developed to collect data from two Chinese OHCs used by cancer survivors. The questionnaire is composed of two parts: six sociodemographic variables (i.e., gender, age, city, education, tenure, and prior Internet experience), two scales for informational support behaviors (i.e., health knowledge seeking and provision of health knowledge), a measure of emotional support within such a setting, and a measure of e-health literacy. Based on 162 complete samples, we determined the measurement properties of the scales used, provided descriptive statistics on major sociodemographic variables and conducted bivariate and multivariable hierarchical regression.

RESULTS

For cancer survivors, females demonstrate higher levels of e-health literacy. Higher education level was related to higher e-health literacy. Health knowledge seeking, contributing to health knowledge, and emotional support were all positively associated with e-health literacy. The interaction effect between health knowledge and emotional support is positively associated with e-health literacy.

CONCLUSIONS

Informational support and emotional support, as two major subtypes of social support within resources available in OHCs, are positively associated with e-health literacy among cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors might benefit from an active strategy for improving personal e-health literacy that includes more active informational involvement and emotional support rather than a passive lurking through e-health information and seeking and reading postings in OHCs.