Systematic Analysis of the Readability of Patient Information on the Websites of Clinics for Plastic Surgery

Zusammenfassung Einleitung: Das Internet gewinnt als Informationsquelle fur Patienten in medizinischen Fragestellungen zunehmend an Bedeutung. Auf der anderen Seite haben viele Patienten Probleme, schriftliche Informationen mit medizinischen Inhalten adaquat aufzunehmen und zu verstehen. Grundbedingung fur ein Textverstandnis ist die Lesbarkeit eines Textes. Ziel der vorliegenden Untersuchung war es, die auf den Internetseiten gro ss er deutscher plastisch-chirurgischer Kliniken verfugbaren Texte mit Patienteninformation hinsichtlich ihrer Lesbarkeit zu untersuchen. Studiendesign: Die Internetseiten von 27 gro ss en Abteilungen fur Hand- und Plastische Chirurgie in Deutschland wurden mithilfe von 5 anerkannten Lesbarkeitsindices einer systematischen Analyse unterzogen. Anhand 20 frei gewahlter fachreprasentativer Suchbegriffe wurde auf den Internetseiten nach passenden Informationstexten gesucht. Alle Texte wurden einem von 3 thematischen Schwerpunkten zugeordnet um adaquate Vergleichsanalysen durchfuhren zu konnen. Neben der Auswertung der Lesbarkeit erfolgte die Analyse weiterer objektiver Textparameter. Ergebnisse: In die schlussendliche Analyse konnten 288 Texte einbezogen werden. Die meisten Texte fanden sich zum Themenkomplex Handchirurgie (n=124), weniger zu den Komplexen plastische Gesichtschirurgie (n=80) und Lappenplastik, Brust- und Rekonstruktive Chirurgie (n=84). Alle angewandten Lesbarkeitsindices zeigten ubereinstimmend eine schlechte Lesbarkeit an, sodass die Texte nur fur Leser mit Hochschulbildung verstandlich erscheinen. Zwischen den Themenkomplexen bestanden keine signifikanten Unterschiede hinsichtlich der Lesbarkeit. Schlussfolgerungen: Gerade in der Kommunikation von medizinischen Informationen ist es wichtig, den Kenntnis- und Bildungsstand des Adressaten zu berucksichtigen. Die untersuchten Texte zeigten ubereinstimmend eine Lesbarkeit an, die in der Regel lediglich fur Akademiker als ausreichend verstandlich ist. Ein Gro ss teil der angestrebten Zielgruppe wird somit wahrscheinlich nicht erreicht. Soll der zunehmenden Bedeutung des Internets als Informationsmedium fur Patienten Rechnung getragen werden, erscheint eine uberarbeitung der Texte sinnvoll. Abstract Objective: The Internet is becoming increasingly important as a source of information for patients in medical issues. However, many patients have problems to adequately understand texts, especially with medical content. A basic requirement to understand a written text is the readability of a text. The aim of the present study was to examine texts on the websites of German plastic-surgical hospitals with patient information regarding their readability. Materials and Methods: In this study, the readability of texts of 27 major departments of plastic and Hand surgery in Germany was systematically analysed using 5 recognised readability indices. First, texts were searched based on 20 representative key words and themes. Thereafter, texts were assigned to one of 3 major themes in order to enable statistical analysis. In addition to the 5 readability indices, further objective text parameters were also recorded. Results: Overall, 288 texts were found for analyzation. Most articles were found on the topic of handsurgery (n=124), less were found for facial plastic surgery (n=80) and flaps, breast and reconstructive surgery (n=84). Consistently, all readability indices showed a poor readability for the vast majority of analysed texts with the text appearing readable only for readers with a higher educational level. No significant differences in readability were found between the 3 major themes. Conclusion: Especially in the communication of medical information, it is important to consider the knowledge and education of the addressee. The texts studied consistently showed a readability that is understandable only for academics. Thus, a large part of the intended target group is probably not reached. In order to adequately deliver online information material, a revision of the analysed internet texts appears to be recommendable

Afatinib in Non-Small Cell Lung Cancer Harboring Uncommon EGFR Mutations Pretreated With Reversible EGFR Inhibitors

Background. Afatinib, an irreversible ErbB family blocker, is approved for treatment of patients with previously untreated non-small cell lung cancer (NSCLC) harboring activating epidermal growth factor receptor (EGFR) mutations. Efficacy of afatinib in EGFR tyrosine kinase inhibitor-naive (TKI-naive) patients with uncommon EGFR mutations (other than exon 19 deletions or exon 21 point mutations) has been reported; however, efficacy in TKI-pretreated patients with uncommon EGFR mutations is unknown. Materials and Methods. In the afatinib compassionate use program (CUP), patients with advanced or metastatic, histologically confirmed NSCLC progressing after at least one line of chemotherapy and one line of EGFR-TKI treatment were enrolled. Demographic data, mutation type, response rates, time to treatment failure (TTF), and safety in patients harboring uncommon EGFR mutations were reported. Results. In 60 patients (63% female, median age 63 years [range: 30-84 years]), a total of 66 uncommon EGFR mutations including 30T790M mutations were reported (18.4% and 11%, respectively, of known EGFR mutations within the CUP). Most patients (67%) received afatinib as third-or fourth-line treatment. Median TTF was 3.8 months (range: 0.2 to >24.6 months; p =.244) in patients with uncommon mutations compared with 5.1 months (range: 0.1 to >21.1 months) in patients with common mutations (n = 165). Pronounced activity was observed with E709X mutations (TTF>12months). No new safety signals were detected. Conclusion. Afatinib is clinically active and well tolerated in many TKI-pretreated NSCLC patients harboring uncommon EGFR mutations. Compared with results reported in TKI-naive patients, activity was also indicated in patients with T790M and exon 20 insertion mutations

Strategies to Overcome Acquired Resistance to EGFR-TKI Therapy Based on T790M Specific Substances using Osimertinib as an Example

Tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR) are widely used in non-small cell lung cancer patients harboring activating EGFR mutations. However, resistance mechanisms, particularly the T790M mutation, hamper longer-term therapeutic success of first and second generation EGFR-TKIs. To address this unmet medical need, EGFR-TKIs of the third generation are under clinical development. Relevant clinical efficacy with mainly mild to moderate class-specific side effects has been shown for third-generation EGFR-TKIs. Molecular testing is of major importance in deciding for treatment with third generation EGFR-TKIs. This article elucidates the developmental state of third generation EGFR-TKIs with its focus on Osimertinib, the first and currently the only compound in this class which is approved in Germany. Additionally, the medical importance of molecular diagnosis using tumor tissue and circulating tumor DNA is discussed