Analysis of Trustworthiness and Readability of English and Spanish Hypo- and Hyperthyroid-Related Online Patient Education Information.

This study aims to determine the readability and trustworthiness of English and Spanish hypo- and hyperthyroid-related online information. Google searches were conducted for four search terms: hypothyroidism, Hashimoto's Disease, hyperthyroidism, and Graves' Disease. For each search term, the first 10 websites were analyzed with a total of 40 websites analyzed. Readability formulas were used to determine English and Spanish readability. Trustworthiness was determined using HONcode status, JAMA Benchmark Criteria, and NLM Trustworthy Score. Overall readability largely exceeded recommended grade levels. Only 1 website (2.5%) presented information below the eighth-grade reading level based on overall Readability Consensus score, while 31 websites (77.5%) exceeded this threshold for all measures. The mean (SD) English readability grade level was 9.6 (3.44); the mean (SD) Spanish grade was 8.5 (4.58). No significant relationships were found between the JAMA Benchmark Criteria, NLM Trustworthy Score, HONcode status, and readability. 67.5% of websites analyzed (n = 27) were certified with the Health on the Net Foundation's code of conduct. Websites about common thyroid-related conditions have overall poor readability. The availability of resources for Spanish-speaking patients is also poor. Steps should be taken to ensure that online health-related materials are comprehensible. Physicians should recognize that patients may have few trustworthy and easy-to-understand sources to access information. The readability and trustworthiness of sources should be considered when providing patients suggested sources for further reading. It may be particularly helpful for physicians to utilize websites with favorable readability scores such as the American Thyroid Association website.

Trends in Male and Female Urethral Endoscopic Management and Urethroplasty Using the TriNetX Database.

BACKGROUND: How quickly providers adapt to new practice guidelines is not well known. The objective of this study was to evaluate temporal trends in the performance of urethral endoscopic management and urethroplasty surrounding the release of the American Urological Association (AUA) Male Urethral Stricture Guidelines in 2017. We also evaluate in parallel trends in female urethral stricture disease, where AUA guidelines are not present. We hypothesized that the ratio of urethroplasty versus urethral endoscopic management in both males and females is increasing and that guidelines do not result in immediate changes in management trends. METHODS: Endoscopic management and urethroplasty data were collected from the TriNetX database on adult males and females five years before (starting 1 January 2012) and after (ending 31 December 2022) the 2017 AUA guidelines. Cohorts were built using Current Procedural Terminology (CPT) codes and grouped into urethral endoscopic management (Males: CPT 52275, 52281, 52282, 53600, 53601, 53620, 53621; Females: CPT 52270, 53660, 53661, 53665) or urethroplasty (Males: CPT 53000, 53010, 53400, 53410, 53415, 53420, 53450, 53460; Females: CPT 53430). Data on patient age, race, and geographic distribution were also collected. RESULTS: In total, 27,623 (Males: 25,039; Females: 2584) endoscopic managements and 11,771 (Males: 11,105; Females: 666) urethroplasties were reviewed across 51 Health Care Organizations. The mean age of endoscopic management and urethroplasty patients was 67.1 and 55.7, respectively (p < 0.01). The urethroplasty-to-endoscopic management ratio decreased for males between 2012 and 2013 and then steadily increased until 2017. The ratio steadily increased for females from 2012 to 2017. The urethroplasty-to-endoscopic management ratio showed a slight decline from 2017 to 2020 across both males and females before rising again through 2022 to a study high (Males: 0.62; Females: 0.63). Regional differences were identified, with the West having the highest urethroplasty-to-endoscopic management ratios for both males and females, the Northeast having the lowest urethroplasty-to-endoscopic management ratio for males, and the Midwest having the lowest ratio for females. CONCLUSIONS: The utilization of urethroplasty for males and females is increasing. An immediate benefit on post-guideline urethroplasty rates was not observed, and the utilization of female urethroplasty increased despite the absence of AUA guidelines. These illustrate that the impact of guideline dissemination takes time and supports the need for continued provider outreach and education on urethral stricture disease and management.

A TriNetX Registry Analysis of the Need for Second Procedures following Index Anterior and Posterior Urethroplasty.

BACKGROUND: We queried a global database to understand re-intervention rates following urethroplasty with the goal of evaluating whether they align with previously published data. METHODS: Using the TriNetX database and Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD) codes, we identified adult male patients with urethral stricture disease (ICD N35) who underwent one-stage anterior (CPT 53410) or posterior urethroplasty (CPT 53415), with or without (substitution urethroplasty) a tissue flap (CPT 15740) or buccal graft (CPT 15240 or 15241). We set urethroplasty as the index event and used descriptive statistics to report the incidence of secondary procedures (using CPT codes) within 10 years after the index event. RESULTS: There were 6606 patients who underwent urethroplasty within the last 20 years, with 14.3% of patients undergoing a second procedure after index event. Upon subgroup analysis, reintervention rates were 14.5% for anterior urethroplasty vs. 12.4% of patients with an anterior substitution urethroplasty (RR 1.7, p = 0.09) and 13.3% for posterior urethroplasty vs. 8.2% for patients with a posterior substitution urethroplasty (RR 1.6, p < 0.01). CONCLUSIONS: Most patients will not need any form of re-intervention following urethroplasty. These data align with previously described recurrence rates, which may help urologists counsel patients considering urethroplasty.

Impact of misinformation on ivermectin internet searches and prescribing trends during COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of publications seeking to understand the SARS-CoV-2 virus. A byproduct of the rush to understand COVID-19 has been the publication and subsequent retraction of papers promoting unfounded treatments, such as ivermectin-an anti-parasitic medication. This study aims to determine the impact retracted studies may have had on ivermectin prescription rates. TriNetX was used to gather anonymized patient data from 67 healthcare organizations both within the USA (36,711 patients; 91.6%) and abroad (3,266 patients; 8.14%) to obtain prescribing rates for ivermectin between April 2020-September 2022. Google Trends was used to gauge online interest in purchasing ivermectin in relation to prescribing rates. We found that ivermectin use largely increased following periods in which later-retracted journal articles were written touting its potential benefits. Multiple spikes in Google searches were observed, with the first three local peaks occurring within the first, second, and third publication 'clusters,' respectively. The maximum peak for searches occurred just one month after the maximum number of ivermectin prescriptions. This information is important for understanding how health-related misinformation spreads, and how to best minimize and counteract the impact of such misinformation in the future.

60 Years after Kefauver: Household income required to buy prescription drugs in the United States and abroad.

BACKGROUND: Assessing drug prices relative to income in the US compared to other Organization for Economic Co-Operation and Development (OECD) countries provides context for policymakers seeking to improve access and affordability. METHODS: Using current drug p. rice and income data, we recreate a historical analysis presented in 1960 to the Senate Subcommittee on Antitrust and Monopoly led by Sen. Estes Kefauver. We identified frequently prescribed generic and brand name drugs for US and international comparison by drug price category (low-price generics, mid-price brands, and high-price specialty brands) as a function of income. We further extend our analysis to consider US prices relative to the current Federal Poverty Level (FPL). RESULTS: For the low-price drugs, all fell below 1% of all of the US income levels presented. Mid-price drugs were below 10% of income for those at the US median household income level but approached 30% of income for those at the FPL. High-price drugs varied greatly, reaching over 600% FPL for one product. CONCLUSIONS: Americans receive bargain prices on par with international comparators for many low-priced generics drugs. For commonly used mid-priced drugs or high-priced specialty products, whether or not drug prices are considered a bargain in the US compared to international markets may depend on individual income. External reference pricing policies may help inform the negotiation for some drug prices, but affordability may still be limited for lower wage earners.