Gender Differences With Ibutilide Effectiveness and Safety in Cardioversion of Atrial Fibrillation

INTRODUCTION

Few studies have examined the use of ibutilide in noncardiac surgical populations. Our study considered the effectiveness and safety of ibutilide in cardioversion of atrial fibrillation (AF) in medical and surgical intensive care patients.

METHODS

A retrospective chart review was performed for patients with a confirmed diagnosis of AF who were hemodynamically stable and received ibutilide after the initial diagnosis. Patients were administered 1 mg of ibutilide fumarate intravenous for 10 min with a second dose administered if AF persisted after 30 min. Patients were pretreated with intravenous magnesium sulfate if their blood magnesium level was <2 mg/dL.

RESULTS

Fifty seven total female patients and 99 male patients received ibutilide. Females had an 88% conversion rate to normal sinus rhythm (NSR) compared to 68% in males (P = 0.008). A 70% successful return to NSR was observed in patients from all groups pretreated with magnesium sulfate (P = 0.045). One year after discharge, 74% of the patients stayed in the NSR.

CONCLUSIONS

Within our population, pretreatment with magnesium sulfate followed by ibutilide was associated with increased conversion to NSR. Additionally, we noted that females had a higher conversion rate to NSR compared to males, regardless of whether they were pretreated with magnesium sulfate.

New Frontiers in Health Literacy: Using ChatGPT to Simplify Health Information for People in the Community

BACKGROUND

Most health information does not meet the health literacy needs of our communities. Writing health information in plain language is time-consuming but the release of tools like ChatGPT may make it easier to produce reliable plain language health information.

OBJECTIVE

To investigate the capacity for ChatGPT to produce plain language versions of health texts.

DESIGN

Observational study of 26 health texts from reputable websites.

METHODS

ChatGPT was prompted to 'rewrite the text for people with low literacy'. Researchers captured three revised versions of each original text.

MAIN MEASURES

Objective health literacy assessment, including Simple Measure of Gobbledygook (SMOG), proportion of the text that contains complex language (%), number of instances of passive voice and subjective ratings of key messages retained (%).

KEY RESULTS

On average, original texts were written at grade 12.8 (SD = 2.2) and revised to grade 11.0 (SD = 1.2), p < 0.001. Original texts were on average 22.8% complex (SD = 7.5%) compared to 14.4% (SD = 5.6%) in revised texts, p < 0.001. Original texts had on average 4.7 instances (SD = 3.2) of passive text compared to 1.7 (SD = 1.2) in revised texts, p < 0.001. On average 80% of key messages were retained (SD = 15.0). The more complex original texts showed more improvements than less complex original texts. For example, when original texts were ≥ grade 13, revised versions improved by an average 3.3 grades (SD = 2.2), p < 0.001. Simpler original texts (< grade 11) improved by an average 0.5 grades (SD = 1.4), p < 0.001.

CONCLUSIONS

This study used multiple objective assessments of health literacy to demonstrate that ChatGPT can simplify health information while retaining most key messages. However, the revised texts typically did not meet health literacy targets for grade reading score, and improvements were marginal for texts that were already relatively simple.

Helping patient educators meet health literacy needs: End-user testing and iterative development of an innovative health literacy editing tool

Objective

The Sydney Health Literacy Lab (SHeLL) Editor is an online text-editing tool that provides real-time assessment and feedback on written health information (assesses grade reading score, complex language, passive voice). This study aimed to explore how the design could be further enhanced to help health information providers interpret and act on automated feedback.

Methods

The prototype was iteratively refined across four rounds of user-testing with health services staff (N = 20). Participants took part in online interviews and a brief follow-up survey using validated usability scales (System Usability Scale, Technology Acceptance Model). After each round, Yardley's (2021) optimisation criteria guided which changes would be implemented.

Results

Participants rated the Editor as having adequate usability (M = 82.8 out of 100, SD = 13.5). Most modifications sought to reduce information overload (e.g. simplifying instructions for new users) or make feedback motivating and actionable (e.g. using frequent incremental feedback to highlight changes to the text altered assessment scores).

Conclusion

terative user-testing was critical to balancing academic values and the practical needs of the Editor's target users. The final version emphasises actionable real-time feedback and not just assessment.

Innovation

The Editor is a new tool that will help health information providers apply health literacy principles to written text.

COVID-19 Testing and Vaccine Willingness: Cross-Sectional Survey in a Culturally Diverse Community in Sydney, Australia

Objective

The current study examined patterns in COVID-19 testing and vaccination intentions across multiple language groups in Greater Western Sydney, Australia.

Methods

Participants completed a cross-sectional survey available from March 21 to July 9, 2021 in Sydney, Australia. Surveys were available in English or translated (11 languages). Participants could complete surveys independently or with support from bilingual staff. Logistic regression models using poststratification weighted frequencies identified factors associated with testing and vaccination intentions.

Results

Most of the 708 participants (88%, n=622) were not born in Australia; 31% reported that they did not speak English well or at all (n=220); 70% had no tertiary qualifications (n=497); and 41% had inadequate health literacy (n=290). Half (53.0%) reported willingness to get a COVID-19 vaccine if recommended to them (n=375); 18% were unwilling (n=127), and the remainder unsure (29%, n=205). These proportions varied significantly by language group (p<0.001). Participants were more likely to be unwilling/hesitant if they were female (p=0.02) or did not use Australian commercial information sources (p=0.01). Concerns about side effects (30.4%, n=102) and safety (23.9%, n=80), were key reported barriers to vaccination. Most participants reported high testing intention (77.2%, n=546), with differences observed across language groups (p<0.001). The most frequently reported barrier to testing was concerns about infection at the clinic (26.1%) followed by concerns that testing was painful (25.3%).

Conclusion

Different language groups have unique and specific needs to support uptake of COVID-19 testing and vaccination. Health services must work collaboratively with culturally and linguistically diverse communities to provide tailored support to encourage COVID-19 testing and vaccination.

Comparison of Readability Scores for Written Health Information Across Formulas Using Automated vs Manual Measures

This cross-sectional study examines the variability of readability scores across widely used online calculators.

Main COVID-19 information sources in a culturally and linguistically diverse community in Sydney, Australia: A cross-sectional survey

OBJECTIVE

Describe COVID-19 information-seeking experiences for culturally and linguistically diverse groups in Sydney, Australia.

METHODS

Cross-sectional survey, translated into 11 languages; participants recruited from March 21 to July 9, 2021. Regression models identified factors associated with difficulty finding easy-to-understand COVID-19 information.

RESULTS

Across 708 participants (88% born overseas, 31% poor English proficiency), difficulty finding easy-to-understand COVID-19 information was rated 4.13 for English (95%CI: 3.85-4.41) and 4.36 for non-English language materials (95%CI: 4.07-4.66) (1 easy to 10 hard). Participants who were older (p < 0.001), had inadequate health literacy (p < 0.001), or poor English proficiency (p < 0.001) found it harder to find easy-to-understand English-language COVID-19 information. Those who had greater difficulty finding easy-to-understand non-English COVID-19 information were younger (p = 0.004), had poor English proficiency (p < 0.001), were university-educated (p = 0.05), and had spent longer living in Australia (p = 0.001). They were more likely to rely on friends and family for COVID-19 information (p = 0.02). There was significant variation in information-seeking experiences across language groups (p's < 0.001).

CONCLUSIONS

Easy-to-understand and accessible COVID-19 information is needed to meet the needs of people in culturally and linguistically diverse communities.

PRACTICE IMPLICATIONS

COVID-19 communication efforts must involve working alongside these communities to leverage existing communication channels and tailor messages.

Psychological, social and financial impacts of COVID-19 on culturally and linguistically diverse communities in Sydney, Australia

OBJECTIVE

To explore the psychological, social and financial outcomes of COVID-19-and the sociodemographic predictors of those outcomes-among culturally and linguistically diverse communities in Sydney, Australia.

DESIGN

Cross-sectional survey informed by the Framework for Culturally Competent Health Research conducted between March and July 2021.

SETTING

Participants who primarily speak a language other than English at home were recruited from Greater Western Sydney, New South Wales.

PARTICIPANTS

708 community members (mean age: 45.4 years (range 18-91)). 88% (n=622) were born outside of Australia, 31% (n=220) did not speak English well or at all, and 41% (n=290) had inadequate health literacy.

OUTCOME MEASURES

Thirteen items regarding COVID-19-related psychological, social and financial outcomes were adapted from validated scales, previous surveys or co-designed in partnership with Multicultural Health and interpreter service staff. Logistic regression models (using poststratification weighted frequencies) were used to identify sociodemographic predictors of outcomes. Surveys were available in English or translated (11 languages).

RESULTS

In this analysis, conducted prior to the 2021 COVID-19 outbreak in Sydney, 25% of the sample reported feeling nervous or stressed most/all of the time and 22% felt lonely or alone most/all of the time. A quarter of participants reported negative impacts on their spousal relationships as a result of COVID-19 and most parents reported that their children were less active (64%), had more screen time (63%) and were finding school harder (45%). Mean financial burden was 2.9/5 (95% CI 2.8 to 2.9). Regression analyses consistently showed more negative outcomes for those with comorbidities and differences across language groups.

CONCLUSION

Culturally and linguistically diverse communities experience significant psychological, social and financial impacts of COVID-19. A whole-of-government approach is needed to support rapid co-design of culturally safe support packages in response to COVID-19 and other national health emergencies, tailored appropriately to specific language groups and accounting for pre-existing health disparities.

Question prompt lists and endorsement of question-asking support patients to get the information they seek-A longitudinal qualitative study

Introduction

Question prompt lists (QPLs) have been found to support patients to ask questions and improve the information they receive from doctors. However, some QPL tools, which have been available online for almost 15 years, have little published data on their impact in real‐world settings. This study's aim was to understand patients' attitudes and experiences accessing health information and to assess the impact of introducing two generic QPLs over 3 months.

Methods

A longitudinal qualitative study consisting of three semi‐structured interviews over a three‐month period was conducted with 31 purposively selected participants, adults ≥18 years, recruited online and through social media. Participants were introduced to two different QPLs currently available online (‘Question Builder’; ‘AskShareKnow’). Inductive thematic analysis of a total of 92 semi‐structured telephone interviews was conducted during May–November 2020.

Results

Three main themes are described. (1) Participants described barriers and facilitators to accessing health information: navigating a complex health system; difficulty asking questions of their healthcare professionals and that they value doctors with good communication skills. (2) QPLs helped some participants recognize the role of question‐asking in consultations, made them feel more empowered and helped them prepare and prioritize. (3) Participants wanted QPLs to be easier to use, be accessible when needed and that question‐asking and QPLs should be normalized in medical consultations.

Conclusions

Well‐designed and easily accessible QPLs can empower people to ask questions and be more involved in decisions about their health care. Endorsement of question‐asking in consultations by healthcare professionals and providing QPL tools at the point of contact with health services will be key to realizing the potential of QPLs.

Patient or Public Contribution

This study was completed in conjunction with a reference group consisting of a consumer representative, representatives from the Australian Commission on Safety and Quality in Health Care, Healthdirect Australia Ltd., and the research team.

The Role of the Urinary Bladder in the Diagnosis of Abdominal Compartment Syndrome: A Prospective Study in Trauma Patients

Purpose The aim of this study was to evaluate the accuracy of bladder pressures in the diagnosis and management of abdominal compartment syndrome (ACS). Methods After Institutional Review Board (IRB) approval, nine operative abdominal trauma patients were prospectively studied over an 18-month period. Bladder pressures were compared to pressures obtained from intra-operatively placed electronic transducer located in the pelvis. Statistical analysis was performed using methods described by Bland and Altman. Results A Bland-Altman plot was used to assess the differences between bladder and transducer pressures. There was little agreement between the two methods at low (10-15 mmHg) and high (30-70 mmHg) pressures. At higher pressures, there was a notable difference between these two types of pressure. No patients required repeated operation. One patient died from severe traumatic brain injury. Conclusion Measurements obtained from the urinary bladder did not agree well with those obtained from within the peritoneal cavity. Furthermore, abdominal pressures greater than 20 mmHg did not show signs of ACS in this selected population, raising doubts about the utility of using abdominal pressures alone in the management of ACS.

A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

BACKGROUND

The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied.

PURPOSE

To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions.

DATA SOURCES

MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs.

STUDY SELECTION

Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations.

DATA EXTRACTION

Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist.

DATA SYNTHESIS

Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials.

LIMITATIONS

Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up.

CONCLUSIONS

PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective.[Box: see text].

Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

BACKGROUND

There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development.

PURPOSE

An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations.

DATA SOURCES

Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions).

STUDY SELECTION

RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s).

DATA EXTRACTION

Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability.

DATA SYNTHESIS

Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ² = 14.11, P = 0.0002, I² = 92.9%).

LIMITATIONS

We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.

Levels of anxiety and distress following receipt of positive screening tests in Australia's HPV-based cervical screening programme: a cross-sectional survey

OBJECTIVE

From December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme.

METHODS

Women in Australia aged 25-74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress.

RESULTS

1004 women completed the online survey; 80.9% reported testing HPV negative (HPV-), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV-. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV-. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV-.

CONCLUSIONS

Receipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.