Aims. The aim of this study was to identify the information topics that should be addressed according to the parents of children with developmental dysplasia of the hip (DDH) in the diagnostic and treatment phase during the first year of life. Second, we explored parental recommendations to further optimize the information provision in DDH care. Methods. A qualitative study with semi-structured interviews was conducted between September and December 2020. A purposive sample of parents of children aged younger than one year, who were treated for DDH with a Pavlik harness, were interviewed until data saturation was achieved. A total of 20 interviews with 22 parents were conducted. Interviews were audio recorded, transcribed verbatim, independently reviewed, and coded into categories and themes. Results. Interviews revealed four fundamental information topics that should be addressed in the different phases of the DDH healthcare trajectory: general information (screening phase), patient-specific information (diagnostic and treatment phase), practical information (treatment phase), and future perspectives (treatment and follow-up phase). To further optimize the information provision in DDH care, parents wished for more accessible and trustworthy general information prior to the first hospital visit to be better prepared for the diagnosis. Furthermore, parents wanted more personalized and visually supported information for a better understanding of the nature of the disease and the reason for treatment. Conclusion. This study offers novel insights to optimize the information provision in DDH care. The main finding is the shift in information need from general information in the screening phase to patient-specific information in the diagnostic and treatment phase of DDH. Parents prefer visually-supported information, provided in a timely fashion, and tailored to their child’s situation. These recommendations potentially decrease parental anxiety, insecurity, confusion, and increase parental empowerment and treatment adherence throughout the diagnostic and treatment phase of DDH. Cite this article: Bone Jt Open 2023;4(7):496–506

Introduction. The use of osseointegrated limb replacement prostheses for amputees are rapidly growing in popularity due to the many benefits over conventional sockets. Many institutions worldwide are beginning to provide this surgical option to their patients and are advertising the service online. The aim of this study was to assess the quality and reading level of related information available online. Materials & Methods. A search was performed using the 3 most popular English language search engines reviewing the top 40 websites from each, using the term osseointegration on. Duplicates, videos, medical journal articles and dentistry websites were excluded. All included websites were assessed for reading using the FKGL, G-Fog and FRE. Quality was assessed using the JAMA benchmark criteria, HONC erificate and a novel 16-point scoring system developed specifically for limb replacement osseointegration. Results. The search resulted in 9,985,000 websites, 120 were assessed. 23 websites were included after removal of duplicates, medical journals and dentistry websites. None with reading grades of 6 or lower. Mean FKGL grade was 11.3/18. Mean FRE was 38.83/100. Mean G-FOG was 12.57/20. No websites had HONC. Mean JAMA score was 1.76/4. Mean HSSOIS was 5.70/16. Most provided information on indications(16/23) and explanation of osseointegration 17/23) but few discussed costs(3/23) or restrictions(9/23). Conclusions. There is already a large amount of information available online regarding osseointegrated prostheses. However, the most accessible information may exceed most patients’ reading levels, limiting is usefulness. Further, the information available is generally of low quality, The quality of information and the readability of online content should be improved to ensure more effective patient education

Aims. Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients’ quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online. Methods. We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers. Results. ‘Total joint replacement’ had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites. Conclusion. Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly

Aims. While internet search engines have been the primary information source for patients’ questions, artificial intelligence large language models like ChatGPT are trending towards becoming the new primary source. The purpose of this study was to determine if ChatGPT can answer patient questions about total hip (THA) and knee arthroplasty (TKA) with consistent accuracy, comprehensiveness, and easy readability. Methods. We posed the 20 most Google-searched questions about THA and TKA, plus ten additional postoperative questions, to ChatGPT. Each question was asked twice to evaluate for consistency in quality. Following each response, we responded with, “Please explain so it is easier to understand,” to evaluate ChatGPT’s ability to reduce response reading grade level, measured as Flesch-Kincaid Grade Level (FKGL). Five resident physicians rated the 120 responses on 1 to 5 accuracy and comprehensiveness scales. Additionally, they answered a “yes” or “no” question regarding acceptability. Mean scores were calculated for each question, and responses were deemed acceptable if ≥ four raters answered “yes.”. Results. The mean accuracy and comprehensiveness scores were 4.26 (95% confidence interval (CI) 4.19 to 4.33) and 3.79 (95% CI 3.69 to 3.89), respectively. Out of all the responses, 59.2% (71/120; 95% CI 50.0% to 67.7%) were acceptable. ChatGPT was consistent when asked the same question twice, giving no significant difference in accuracy (t = 0.821; p = 0.415), comprehensiveness (t = 1.387; p = 0.171), acceptability (χ. 2. = 1.832; p = 0.176), and FKGL (t = 0.264; p = 0.793). There was a significantly lower FKGL (t = 2.204; p = 0.029) for easier responses (11.14; 95% CI 10.57 to 11.71) than original responses (12.15; 95% CI 11.45 to 12.85). Conclusion. ChatGPT answered THA and TKA patient questions with accuracy comparable to previous reports of websites, with adequate comprehensiveness, but with limited acceptability as the sole information source. ChatGPT has potential for answering patient questions about THA and TKA, but needs improvement. Cite this article: Bone Jt Open 2024;5(2):139–146

Background. Information about low back pain (LBP) and help to support patients' self-management are recommended in the majority of guidelines for LBP management. However, the delivery of patient information and advice can be time consuming, and with short available consultation times for general practitioners (GPs), new methods to support the delivery of sufficient patient information is called for. Purpose. To identify general practitioners' perspectives on recommending online information to patients with LBP. Methods. Danish GPs varying in age and professional interests were recruited to interviewing in their practices (their working environment). The interviews were based on a semi-structured interview guide, based on a value-led method, and inspired by think aloud methods,. Results. Eight 60-Minutes interviews were conducted. For GPs to recommend online LBP information, it is essential to target the information to their patients. GPs expressed the possible advantages by involving both healthcare professionals and patients in the development of the online information material by aligning the content with the face-to-face delivered information. Furthermore, the content should be guideline concordant. However, GPs expressed that some patients had problems with accessing and understanding health-related LBP information. Conclusion. When developing online information, the content should be supported by evidence and it is important to involve patients' and GPs' preferences in the design process. Consequently, including the elements in evidence-based medicine. However, GPs do not consider online information material to be suited to all. No conflicts of interest. Sources of funding: Funded by ARs' Honour in Medical Research from Magda and Svend Aage Friederichs Memorial Fund and the Novo Nordic Foundation

PURPOSE. YouTube is a video sharing platform that is a common resource for patients seeking medical information. The objective of this study is to assess the educational quality of YouTube videos pertaining to total knee arthroplasty and knee arthritis. METHODS. A systematic search for the terms “knee replacement” and “knee arthritis” was performed using Youtube's search function. Data from the 60 most relevant videos were collected for each search term. Videos not in English or those without audio or captions were excluded. Quality assessment checklists with a scale of 0 to 10 points were developed to evaluate the video content. Videos were grouped into poor quality (grade 0–3), acceptable quality (grade 4–7) and excellent quality (grade 8– 10), respectively. Four independent reviewers assessed the videos using the same grading system and independently scored all videos. Discrepancies regarding the scoring were clarified by consensus discussion. RESULTS. Overall 106 videos were categorized. For videos regarding total knee replacements, the average number of views was 135,074 with an average duration of 14.53 minutes. Half of the videos were published by a physician or hospital sponsor and were for educational purposes. 64% of videos were of poor educational quality (32/50), 28% were of acceptable quality (14/50), and 8% were of good educational quality (4/50). Common missing information included discussion of surgical complications and implant duration. For videos regarding knee arthritis, the average number of views was 243,346 with an average duration of 4.97 minutes. 39% were published by a physician or hospital sponsor, with 64% of videos made for educational purposes. 66% of videos were of poor educational quality (37/56), 32% were of acceptable quality (18/56), and 2% were of good educational quality. The most common missing information were causes and risk factors for knee arthritis and long-term prognosis. CONCLUSIONS. The present study suggests that YouTube is a poor educational source for patients regarding knee arthroplasty and knee arthritis. Recognizing the limitations of YouTube as well as which topics are not commonly presented may guide clinicians to better educate their patients

Background. 80% of health data is recorded as free text and not easily accessible for use in research and QI. Natural Language Processing (NLP) could be used as a method to abstract data easier than manual methods. Our objectives were to investigate whether NLP can be used to abstract structured clinical data from notes for total joint arthroplasty (TJA). Methods. Clinical and hospital notes were collected for every patient undergoing a primary TJA. Human annotators reviewed a random training sample(n=400) and test sample(n=600) of notes from 6 different surgeons and manually abstracted historical, physical exam, operative, and outcomes data to create a gold standard dataset. Historical data collected included pain information and the various treatments tried (medications, injections, physical therapy). Physical exam information collected included ROM and the presence of deformity. Operative information included the angle of tibial slope, angle of tibial and femoral cuts, and patellar tracking for TKAs and approach and repair of external rotators for THAs. In addition, information on implant brand/type/size, sutures, and drains were collected for all TJAs. Finally, the occurrence of complications was collected. We then trained and tested our NLP system to automatically collect the respective variables. Finally, we assessed our automated approach by comparing system-generated findings against the gold standard. Results. Overall, the NLP algorithm performed well at abstracting all variables in our random test dataset (accuracy=96.3%, sensitivity=95.2%, specificity=97.4%). It performed better at abstracting historical information (accuracy=97.0%), physical exam information (accuracy=98.8%), and information on complications (accuracy=96.8%) compared to operative information (accuracy=94.8%), but it performed well with a sensitivity and specificity >90.0% for all variables. Discussion. The NLP system achieved good performance on a subset of randomly selected notes with querying information about TJA patients. Automated algorithms like the one developed here can help orthopedic practices collect information for registries and help guide QI without increased time-burden. For any tables or figures, please contact the authors directly

Background: Despite the benefits of quality information material, there is a dearth of research on the information needs of people with scoliosis (PwS). The aim of this study was to identify the information needs of PwS including preferences for the presentation of benefit/ risk information, in order to inform the design of written information for this population. Methods: A questionnaire-based design was used to identify the importance attached to characteristics of information material, scoliosis-related knowledge, preferred treatment decision-making role, preferences for presentation of risk information and current information needs. A sample of 73 PwS (86% female, mean age 41.9 years). The majority (74%) had at least an A’ level standard of education and 60% had undergone some type of surgery. The importance of 13 characteristics of information material was assessed using criteria described by previous research. 1. PwS were asked to rate their level of knowledge on 20 scoliosis-related topics. The Control Preference Scale was used to assess treatment decision-making role. Preferences for the presentation of risk information was assessed in terms of (a) absolute versus relative risk, (b) loss versus gain information, and (c) perceived clarity of different methods for presenting benefit/risk information. An open-ended question requested PwS to state their current information needs. Results: Characteristics of information material assigned the highest importance were: information on benefits/ risks of treatment; coverage of all relevant treatments; and clear information on probability of benefits/risks of treatments. Scoliosis-related knowledge was rated below average for 14 of the 20 topics. The majority (88%) expressed a preference for an active or collaborative role in treatment decisions. The majority also preferred to be presented with information on benefits/ risks in both absolute and relative terms, and informed of both loss and gain information. Bar graphs and pie charts were assigned the highest clarity ratings for the presentation of benefit/risk information. Content analysis revealed 27 mutually exclusive categories of current information needs and the rank order of the top 3 were: psychological services and psychosocial support; surgery; and aftercare and self-management. Conclusion: PwS lack knowledge about their condition, desire both psychological and medical information and wish to be involved in treatment decisions. Based on the results, written information will be designed to address the salient information needs of PwS. It is anticipated, following further evaluation that these materials could be used to impact positively upon clinical outcomes such as psychosocial functioning, patient satisfaction and participation in shared decision-making

Background. Online video is increasingly becoming a key source for people to satisfy their information needs. YouTube is one of the post popular websites used for information exchange, with more than one billion unique visitors every month. Questions/purposes. In an attempt to participate in personal health decisions related to hip arthritis, patients may access YouTube for further information. As YouTube is a non peer-reviewed platform and little is known about the quality of available videos. We therefore asked the following research questions: (1) What is the information quality of YouTube videos related to the diagnosis of hip arthritis and (2) what information for the treatment of hip arthritis can be found on YouTube?. Methods. YouTube search was performed on December 23, 2014 for videos related to the diagnosis and the treatment of hip arthritis. The following search terms were used: (1) hip arthritis, (2) hip arthritis symptoms, (3) hip arthritis diagnosis, (4) hip arthritis treatment and (5) hip replacement. After exclusion of videos that did not meet the inclusion criteria, 133 videos were analyzed. In order to qualitatively assess the YouTube video content for to the diagnosis and the treatment of hip arthritis, two new grading systems with a scale of 0 to 12 points were developed. Videos were grouped into poor quality (grade 0–3), moderate quality (grade 4–7) and excellent quality (grade 8–12), respectively. Videos were categorized into the following: educational-physician, educational- non physician, commercial, technique, personal testimony or other. Results. The vast majority of YouTube videos lack essential information for an appropriate diagnosis of hip arthritis. Eighty-four percent (n=112) were graded as being of poor quality, 14 percent (n=19) of moderate quality and only 2 percent (n=2) of excellent quality, respectively. The information quality of educational-physician videos for the diagnosis of hip arthritis was significantly higher (p < 0.001) than for educational-non physician videos. YouTube is a poor information source for the treatment of hip arthritis. In 86 percent (n=114), videos provided poor information quality. Eleven percent (n=15) of videos had a moderate quality and only 3 percent (n=4) an excellent quality, respectively. The quality of information for the treatment of hip arthritis was significantly higher (p = 0.005) than the quality of information for the diagnosis of hip arthritis. Conclusions. The present review of YouTube video material demonstrates that hip arthritis diagnosis and treatment information is overall insufficient. The exchange of video-based information is going to grow rapidly within the next years and videos going to become the primary source of information. The medical community should take chance of the opportunity the define gold standards for comprehensive and innovative evidence-based educational videos addressing the diagnosis and treatment of hip arthritis

Background. There is significant variation and inconsistencies in the current advice and information delivered to patients undergoing total hip replacement (THR). The aim of this study was to assess a locally developed web-based electronic resource system for patients undergoing total hip replacement (THR) surgery to see if this improves and standardises the content, structure, and delivery of information delivered to patients prior to and after surgery. Patients/Materials and Methods. Prospective study with patients recruited in clinic when listed for THR surgery. Patients are emailed login details for the web based electronic resource system (GoWellHealth). The platform delivers content in a time-lined fashion and is individualised to the patient. Data gathered includes the number of patients registering to use this system, their engagement and use of the resources, and results from forms and questionnaires administered. Results. Over a period of 11 months, 228 patients of the 302 activated their accounts (75%). The average age of patients was 64 years (range 33–94 years). A total of 107 patients have had surgery where 76% (n=81) activated their account and of these 81% had been actively using the system. Patients spent on average 2 hours and 2 minutes on the system. Overall 1448 separate ‘hits’ were recorded with each person viewing an average of 31 pieces of content (Range 1 to 90). Computers (45%) were the most commonly used device to access the platform. Discussion. Age did not seem to be a factor and the mean of the most enthusiastic users was greater than the mean of the entre cohort. This system allows data collection and PROMs measurement and supports the consent process. Conclusion. We have shown that patients will engage with an online system and believe it as a useful method of delivering information to our patients; thus, improving their overall surgical care

Background. A cornerstone in treating low back pain (LBP) is the provision of information to patients, and the internet is increasingly being used as a source of health information delivery. However, the effect of and satisfaction with online information have been questioned. Purpose. To develop a multi-item instrument to measure an index score of satisfaction with online information for patients with LBP. Methods. The conceptualization of this patient reported outcome is modelled on the assumption of a formative model. The first draft of the questionnaire was developed based on a previous published interview study of 15 patients and evaluated for face validity by seven experts. The second draft of the questionnaire was pilot-tested in 20 patients to optimize content validity. Patients were recruited from a rehabilitation center and from social media. Results. An eight-item questionnaire was developed after assessing content and face validity. The items were related to design, readability, customization, credibility, usability, and coping. A labelled categorical scale was used for response options. Each item is scored from 0–3, where 0 indicates not at all satisfied, 1 indicates little satisfaction, 2 indicates some satisfaction, and 3 indicates very satisfied giving an overall index score between 0 and 24 points. Conclusion. An eight-item questionnaire measuring satisfaction with an index score from 0–24 points has been developed. The OPSI questionnaire is now being tested for construct validity, reproducibility and interpretation on 150 patients with LBP. No conflicts of interest. Sources of funding: Funded by the Novo Nordic Foundation (NNF17OC0024422)

Purpose: To check the accuracy of the Internet-derived medical information. Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and < 3 being invalid. Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid. Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities

Currently, all details regarding implants are entered into a real time application on the Musgrave Park Hospital site using the Belfast Orthopaedic Information System (BOIS). This is a visual basic client application with data being stored in an SQL server database. This data collection system operates throughout every location within the hospital including the theatre block. Loss of continuity occurs however when joint replacement takes place in Musgrave Park Hospital and then revision surgery or other procedures are carried out at other locations. The goal therefore of the Northern Ire-land Implant Register is to collect information on all implants performed and their revisions regardless of their location. The dataset collected is based on the work of the National Joint Replacement Registry. Our system is designed to support and extend that dataset to provide a more comprehensive joint replacement registry database. This means that reports can be provided to individual sites and data entered into the National registry if required at a later stage. At present every hospital in Northern Ireland is connected to the HPSS network (similar to the HPSSNet in the UK). What has been developed is a web browser based front end, which requires no complex software installation on any client machine. From this web based tool, staff at other locations can access information held at Musgrave Park Hospital, they can select an implant, or record a new implant and then link any revisions or other procedures carried out. As all of the information is entered directly into the BOIS database, there is no delay in the information being available to all who access the system. This reduces the need for case notes to be transferred to other sites and the need to contact the other site directly regarding the case. The interface also provides a comprehensive reporting capability so that commonly requested standard reports are available for authorized staff to run from their web browser. We present an overview of how the web interface works in practice and how data is entered into the system

The purpose of the study was to determine the percentage of knowledge retained immediately following an outpatient consultation for total hip and knee joint arthroplasty, and whether any improvement in that knowledge occurred after reading an information leaflet about the operation. Patients who were placed on the waiting list for joint replacement surgery, were verbally given information during the consultation about basic operative details, post-operative programme, and potential complications. A questionnaire was completed asking them to recall these details. Information leaflets were then given to them to read. 6 weeks later they were again contacted and asked the same questions. Immediately following a consultation, patients recall only a small percentage of information. In particular, retention of post-operative recovery time frames (51–63%), and possible operative complications (0–61 %). Despite an information booklet, their level of knowledge deteriorates from the initial consultation. Verbal and written information supplied to a patient, may be understood, but it is easily and quickly forgotten. In an increasingly medico-legal environment it is essential to gain an informed consent from a patient when performing interventions. The provision of an information booklet may provide nothing more than proof for the surgeon of information provision to the patient

Purpose. To compare information on heredity among patients with idiopathic scoliosis. Methods. 1440 patients with idiopathic scoliosis were recruited. Information on prevalence of scoliosis among relatives was obtained by questionnaire. Results. 1256 (87%) were women and 184 (13%) were men. 204 (14%) of the participants were juvenile (4-9 yrs) at time of diagnosis. 1236 (86%) were adolescents (10-19 yrs) at time of diagnosis. 141 of the 204 patients (69%) with juvenile scoliosis had been treated (73 brace, 68 surgery) and 817 of the 1236 patients (66%) with adolescent scoliosis had been treated (490 brace, 327 surgery). 23% had at least one parent and 13% had at least one grandparent with scoliosis. When comparing female and male patients there was no difference in proportion of parents with scoliosis (p=0.97, Chi-square) or grandparents with scoliosis (p=0.35). 26% of patients with juvenile scoliosis had at least one parent with scoliosis compared to 22% for patients with adolescent scoliosis (p=0.23). 18% of patients with juvenile scoliosis had at least one grandparent with scoliosis compared to 12% for patients with adolescent scoliosis (p=0.04). When dividing the patients into groups according to treatment (observed, brace, or surgery), there was no difference in proportion of parents with scoliosis (p=0.59) or in proportion of grandparents with scoliosis (p=0.99). Conclusion. It is unlikely that information on heredity is of importance for the prognosis of idiopathic scoliosis. We found no difference in heredity among patients with juvenile and adolescent scoliosis or between males and females

Purpose. To determine the impact of sonographic information on surgeons' diagnostic thinking and decision-making in the management of infants with clinically suspicious hip dysplasia. Four experienced consultant surgeons examined 66 hips referred for possible hip dysplasia and reported for each hip (i) the confidence level (visual analogue scale 0-100) about the diagnosis of this hip, and (ii) how they would manage the hip. Each infant was referred to ultrasound and the same surgeon repeated the rating with the sonographic information available. We determined the efficiency in diagnostic thinking and calculated the mean gain in diagnostic confidence that was provided by the sonographic information. We also determined the therapeutic efficacy, ie the impact of ultrasound information on surgeons’ management plans. The ultrasound led to a change in diagnosis in 34/66 (52%) hips. However, the management plan only changed in 21/66 (32%) hips. The mean gain in reported diagnostic confidence was 19.37 (95% CI = 17.27, 21.47). If the treatment plan did not change, there still was a gain in diagnostic confidence but this gain was small with a mean value of 8 (95% CI = 5.29, 10.70). However, if the ultrasound led to a change of the treatment plan, the mean gain in diagnostic confidence was much higher with 46 (95% CI = 30.53, 60.79). The difference was -37.67 (P < 0.0001). Ultrasound was most useful (mean gain >30) in hips demonstrating limited abduction or a positive Galeazzi sign. Conclusion. In this study, the sonographic information only led to a modest gain in diagnostic confidence. Ultrasound was particularly helpful for surgeons in clarifying hips with limited abduction or signs of leg length difference

Background: More patients are turning to the Internet for health-related information. Studies indicate that this information is being used to make decisions about their management. The aim of this study was to assess the information available specific to scoliosis on the Web using four common search engines. Methods: Four search engines (Google, Yahoo, Hotmail and Ask Jeeves) were used in scanning the Web for the following key word- “Scoliosis”. Both U.K. only and World Wide sites were accessed. Four Spinal Surgery Consultants independently graded each site for layout, content, relevance to patients as opposed to medical professionals, ease of use and links to other sites. Each point was marked on a scale of 0–2 and a total of 10 points available. Web sites were assessed via U.K. search engines and forty via World Wide search engines. Good was awarded to a site with a score of 7–10; an average awarded for a score of 4–7 and poor was given to a site with a score of 0–4. Results: For the U.K. search engines, twenty sites were evaluated and five common sites identified (spineuniverse.com, S.A.U.K.org, orthoteers.co.uk, B.O.A.ac. uk and scoilosis.info). From these sites only two were given a rating of good. For the World Wide Web search engines eighteen sites evaluated and seven common sites identified (SRS, spineuniverse.com, scoliosis.org, orthinfo.aaos.org, iscoliosis.com, scoliosisrx.com and scoliosis-world.com). From these sites four were given a rating of good. It was evident that the Scoliosis Association of United Kingdom did not appear in three of the search engines but only in Hotmail. Conclusion: These results suggest that there are good sites available for patients to access information with regards to their condition and treatment options but there are also very poor sites available where incorrect information is available. Commonly, unfamiliar users of the Web will not search U.K. sites specifically and could easily miss the S.A.U.K. site, which is an excellent site and was one of the two sites via the U.K. search engine awarded a good score. Obviously, there were more good sites via the World Wide Web due to the American healthcare system. We recommend that leaflets should be available to parents and patients with scoliosis with information from the BSS of the condition and available Web sites with good ratings. Also we recommend that these sites be linked to the Royal College of General Practitioners Web site to provide reference on good practice

Aim. To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS). Methodology. This was a National Research Ethical Committee approved RCT study. 63 patients underwent EULSS, out of which 14(29%) declined participation and 14(29%) were excluded. One did not have surgery therefore 34 were randomised to Standard (S) and intervention group (I) using sealed envelope. Standard group were given verbal information & leaflet while the Intervention group were given information on relevant section of . www.eurospine.org. and . www.spinesurgeons.ac.uk. websites. A 13 item Informed Consent Questionnaire (ICQ) was used to collect data. The primary outcomes were patients' perceived understanding of reason and risk of EULSS. Results. Average age was 54 (21–82) years, with similar demographics in both groups. Complete data was available for 20 (13 Standard and 7 Intervention group). No difference (χ. 2. = 0.42, df=1, p= 0.52) was observed on perception of reason and risk of surgery between two groups. Website usage increased from 30% to 50% in intervention group who continued to use the website. Conclusion. Website use appears to be useful to participants. Although support has not been found to accept the experimental hypothesis, valuable information has been gained that will serve to facilitate larger study to further explore the effectiveness of websites in enhancing of EULSS. No Conflict of interest. No funding obtained. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Informed consent is vital to good surgical practice. Pain, sedative medication and psychological distress resulting from trauma are likely to adversely affect a patient's ability to understand and retain information thus impairing the quality of the consent process. This study aims to assess whether provision of written information improves trauma patient's recall of the risks associated with their surgery. 121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process. Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p=0.0014 using the Mann-Whitney U test. Patient satisfaction with the consent process was significantly improved in the group receiving written and verbal information, 97.9% of patients reported that they understood the risks of surgery when they signed the consent form compared to 83.2% who received verbal information alone (p=0.01). The majority of patients who received written information reported finding it helpful (93.8%) and most of the patients who did not receive written information reported they would have found it useful had it been offered (66%). Patients awaiting surgery following trauma can pose a challenge to adequately inform about benefits conferred, the likely post operative course and potential risks. Written information is a simple and cost-effective means to improve the consent process and was popular with patients

Objective: To determine whether patient information leaflets improve patient recall during the process of informed consent. Design: Prospective randomised controlled trial which compared a group of patients who were posted a patient information leaflet with those given verbal consent only. Setting: Orthopaedic Unit of a District General Hospital. Patients: 110 patients were selected, of which 57 were randomly allocated to receive patient information leaflets through the post and 53 were given verbal consent only. Outcome Measure: The recall of information given to the patient. This was tested using a questionnaire on admission. Each patient was allocated a score out of ten. Results: There was a significant difference between the group who received patient information leaflets compared to those who did not (P< 0.0001, CI 2.0 to 3.1). Conclusion: Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent