Evaluating the Quality and Readability of Online Resources on Unspecified Kidney Donation.

BACKGROUND: Unspecified kidney donation (UKD) refers to transplantation from donors unrelated and unknown to the recipient. UKD has contributed to the expansion of the live donor pool in several countries. The United Kingdom Transplant Community has set maximizing UKDs as a priority. The Internet raises awareness and potentially influences the decision-making regarding UKD. This is the first study assessing the quality and readability of online material on UKD. MATERIALS AND METHODS: Google was searched for the terms "kidney donation" and one of "unspecified," "altruistic," "non-directed," "anonymous," or "good Samaritan," as well as "giving or donating a kidney to a stranger." Two independent assessors reviewed the top 100 websites. Quality was assessed using the Journal of the American Medical Association criteria, the DISCERN instrument and Health On the Net Code certification. Readability was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG), and Simple Measure of Gobbledygook (SMOG) scores. RESULTS: Only 6% of websites displayed HONcode certification. The mean (± SD) JAMA and DISCERN scores of 1.96 (± 1.00) and 32.34 (± 11.19) indicate poor quality. The mean (± SD) FRE, FKG, and SMOG scores of 52.92 (± 13.62), 10.60 (± 2.72), and 9.64 (± 2.22) reveal poor readability. The difference in JAMA and DISCERN scores according to website classification was significant (P < .001, P = .014) with websites from medical, nonprofit, and governmental organizations scoring amongst the lowest, while comprising most search results (61%). CONCLUSIONS: Transplant centers and medical organizations should prioritize improving their online resources to lower the risk of individuals pursuing UKD based on unrealistic expectations or being discouraged unjustly.

Improving Rehabilitation Information-Giving to Intensive Care Unit Survivors to Aid in Physical and Psychological Recovery.

Intensive care unit (ICU) survivors have an increased mortality rate and reduced quality of life associated with post-ICU syndrome: a triad of physical, psychiatric and cognitive decline. Following evidence on the benefits of early rehabilitation, the National Institute of Clinical Excellence (NICE) CG83 guidelines instruct the provision of rehabilitation information to ICU patients before discharge. Only 33% of UK trusts meet these guidelines. The aim of this project was to reach 100% patient and ICU therapist satisfaction with the rehabilitation information given before ICU discharge at Medway Maritime Hospital, within four months. Patient and therapist satisfaction was assessed using questionnaires at baseline and following each Plan-Do-Study-Act (PDSA) cycle. In PDSA1, a generalised rehabilitation information booklet was created and distributed to ICU survivors pre-discharge. For PDSA2, a personalised rehabilitation plan completed by therapists was added. During PDSA3, the booklet was enriched with mental health and speech and language therapy sections. Results showed a shift in patient satisfaction scores, indicating a significant change in the median from 20% at baseline to 87% after PDSA3. This was also reflected in the therapist satisfaction scores, which increased significantly from 60% at baseline to 100%. The introduction of a generalised information booklet, supplemented with a personalised recovery plan, is an effective way of increasing critical care patient and therapist satisfaction with post-discharge rehabilitation information provision. This should translate to greater patient engagement with rehabilitation and improved long-term outcomes. This is ever more pertinent, as the COVID-19 pandemic will exponentially increase the numbers of ICU survivors at risk of long-term morbidity and mortality.

Cardiac Myosin-Binding Protein C to Diagnose Acute Myocardial Infarction in the Pre-Hospital Setting.

Background Early triage is essential to improve outcomes in patients with suspected acute myocardial infarction (AMI). This study investigated whether cMyC (cardiac myosin-binding protein), a novel biomarker of myocardial necrosis, can aid early diagnosis of AMI and risk stratification. Methods and Results cMyC and high-sensitivity cardiac troponin T were retrospectively quantified in blood samples obtained by ambulance-based paramedics in a prospective, diagnostic cohort study. Patients with ongoing or prolonged periods of chest discomfort, acute dyspnoea in the absence of known pulmonary disease, or clinical suspicion of AMI were recruited. Discrimination power was evaluated by calculating the area under the receiver operating characteristics curve; diagnostic performance was assessed at predefined thresholds. Diagnostic nomograms were derived and validated using bootstrap resampling in logistic regression models. Seven hundred seventy-six patients with median age 68 [58;78] were recruited. AMI was the final adjudicated diagnosis in 22%. Median symptom to sampling time was 70 minutes. cMyC concentration in patients with AMI was significantly higher than with other diagnoses: 98 [43;855] versus 17 [9;42] ng/L. Discrimination power for AMI was better with cMyC than with high-sensitivity cardiac troponin T (area under the curve, 0.839 versus 0.813; P=0.005). At a previously published rule-out threshold (10 ng/L), cMyC reaches 100% sensitivity and negative predictive value in patients after 2 hours of symptoms. In logistic regression analysis, cMyC is superior to high-sensitivity cardiac troponin T and was used to derive diagnostic and prognostic nomograms to evaluate risk of AMI and death. Conclusions In patients undergoing blood draws very early after symptom onset, cMyC demonstrates improved diagnostic discrimination of AMI and could significantly improve the early triage of patients with suspected AMI.