Numerous breast cancer risk assessment tools that allow users to input personal risk information and obtain a personalized breast cancer risk estimate are available on the Internet. The goal of these tools is to increase screening awareness and identify modifiable health behaviors; however, the utility of this risk information is limited by the readability of the material. We undertook this study to assess the overall readability of breast cancer risk assessment tools and accompanying information, as well as to identify areas of suggested improvement. We searched for breast cancer risk assessment tools, using five search terms, on three search engines. All searches were performed on June 12, 2014. Sites that met inclusion criteria were then assessed for readability using the suitability assessment of materials (SAM) and the SMOG readability formula (July 1, 2014–January 31, 2015). The primary outcomes are the frequency distribution of overall SAM readability category (superior, adequate, or not suitable) and mean SMOG reading grade level. The search returned 42 sites were eligible for assessment, only 9 (21.4 %) of which achieved an overall SAM superior rating, and 27 (64.3 %) were deemed adequate. The average SMOG reading grade level was grade 12.1 (SD 1.6, range 9–15). The readability of breast cancer risk assessment tools and the sites that host them is an important barrier to risk communication. This study demonstrates that most breast cancer risk assessment tools are not accessible to individuals with limited health literacy skills. More importantly, this study identifies potential areas of improvement and has the potential to heighten a physician’s awareness of the Internet resources a patient might navigate in their quest for breast cancer risk information.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3601-2) contains supplementary material, which is available to authorized users.

Background To investigate mechanisms underlying our previous observation of a large rise in serum prostate-specific antigen, a marker of prostate pathology, during both sexually transmitted and systemic infections, we measured serum high-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, in our previous case-control study of young, male U.S. military members and compared our findings to those for PSA. Methods We measured hsCRP before and during infection for 299 chlamydia, 112 gonorrhea, and 59 non-chlamydial, non-gonococcal urethritis (NCNGU) cases; before and after infection for 55 infectious mononucleosis (IM) and 90 other systemic/non-genitourinary cases; and for 220–256 controls. Results Only gonorrhea cases were significantly more likely to have a large hsCRP rise (≥1.40 mg/L or ≥239%) during infection than controls (p<0.01). However, gonorrhea, IM, and other systemic/non-genitourinary cases were more likely to have a rise of any magnitude up to one year post-diagnosis than controls (p=0.038–0.077). Conclusions These findings, which differ from those for PSA, suggest distinct mechanisms of elevation for hsCRP and PSA, and support both direct (e.g., prostate infection) and indirect (e.g., systemic inflammation-mediated prostate cell damage) mechanisms for PSA elevation. Future studies should explore our PSA findings further for their relevance to both prostate cancer screening and risk.

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Introduction: The post-anesthesia care unit (PACU) is a clinical area designated for patients recovering from invasive procedures. There are typically several geographically dispersed PACUs within hospitals. Patients in the PACU can be unstable and at risk for complications. However, clinician coverage and patient monitoring in PACUs is not well regulated and might be sub-optimal. We hypothesize that a telemedicine center for the PACU can improve key PACU functions. Objectives: The objective of this study is to demonstrate the potential utility and acceptability of a telemedicine center to complement the key functions of the PACU. These include participation in hand-off activities to and from the PACU, detection of physiological derangements, identification of symptoms requiring treatment, recognition of situations requiring emergency medical intervention, and determination of patient readiness for PACU discharge. Methods and analysis: This will be a single center prospective before-and-after proof-of-concept study. Adults (18 years and older) undergoing elective surgery and recovering in two selected PACU bays will be enrolled. During the initial three-month observation phase, clinicians in the telemedicine center will not communicate with clinicians in the PACU, unless there is a specific patient safety concern. During the subsequent three-month interaction phase, clinicians in the telemedicine center will provide structured decision support to PACU clinicians. The primary outcome will be time to PACU discharge readiness determination in the two study phases. The attitudes of key stakeholders towards the telemedicine center will be assessed. Other outcomes will include detection of physiological derangements, complications, adverse symptoms requiring treatments, and emergencies requiring medical intervention. Registration: This trial is registered on clinicaltrials.gov, NCT04020887 (16th July 2019).

Introduction: Quality improvement (QI) in healthcare results in better patient outcomes, healthcare system performance, and professional development. One target of QI initiatives in the perioperative period is surgical site infections (SSI), for which several risk factors have been identified. Reliable administration of indicated surgical antibiotic prophylaxis is a modifiable factor of particular relevance. We hypothesize that a novel telemedicine-augmented quality improvement program will improve administration of surgical antibiotic prophylaxis. Objectives: The objective of this QI study is to evaluate the utility of a telemedicine-augmented QI initiative on administration of timely surgical antibiotic prophylaxis. The incidence of SSI will also be reported for multiple surgical services. Methods: This will be a multi-center prospective before-and-after proof-of-concept study. Patients undergoing a surgical procedure across seven operating room facilities at four hospitals in the BJC Healthcare System will be included. Approximately 40,000 patients over an eight-month period will be enrolled. This eight-month period will include a baseline observational phase, an education intervention phase, an intervention phase employing real-time event detection with associated guidance from a remote telemedicine center, and a subsequent observational phase. The primary outcome will be administration of on-time surgical antibiotic prophylaxis throughout the trial. Other outcomes will include incidence of SSIs. Registration Information: This trial is registered on clinicaltrials.gov, NCT04983329 (30th July 2021).