Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

ObjectiveThis study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures.MethodsThis randomized control study (N = 66) compared intervention and control groups of students (n = 28) and residents’ (n = 38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures.ResultsFollow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p = 0.007, r = −0.47; breast cancer (BC), p = 0.003, r = −0.53), attention to patient responses after BBN (CC, p < 0.001, r = −0.74; BC, p = 0.001, r = −0.65), and addressing feelings (BC, p = 0.006, r = −0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r = −0.43), communication related to emotions (p = 0.034, r = −0.30), determining patient’s readiness to proceed after BBN and communication preferences (p = 0.041, r = −0.28), active listening (p = 0.011, r = −0.37), addressing feelings (p < 0.001, r = −0.65), and global interview performance (p = 0.001, r = −0.51).ConclusionThis brief BBN training module is an effective method of improving BBN communication skills among medical students and residents.Practice implicationsImplementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.     

With whom did you have sex? Evaluation of a partner notification training for STI professionals using motivational interviewing

ObjectiveTo enhance partner notification (PN) practices in Dutch STI clinics, a PN training using motivational interviewing as core strategy was offered to STI professionals and evaluated.MethodsThe effectiveness of PN training on professionals’ attitude, self-efficacy, skills and behavior toward PN, was examined using within-subject and between-subject comparison. Before the training and at three months follow-up, a questionnaire was completed by the intervention group (n = 54) and a non-random control group (n = 37).ResultsIn the within-subject comparison, positive changes were observed in self-efficacy, skills, and PN behaviors (all p < .05), but not in attitudes toward PN. When we examined differences in change-scores between the intervention and control group, self-efficacy was no longer significant.ConclusionThe PN training significantly improved PN skills and -behavior, but had no effect on professionals’ attitudes or self-efficacy toward PN. The selection of a convenience control sample seems to offer a more rigorous test of hypotheses than pre–post evaluation only.Practice implicationsThe beneficial effect of PN training of STI professionals seems to support a wider roll-out of the training to all STI clinics in the Netherlands, although effects on the number of partners notified and transmissions prevented need to be examined in future research.     

Efficient assessment of depressive symptoms and their prognostic value in myocardial infarction patients

BackgroundIdentification of post-myocardial infarction (MI) depressive symptoms is a major concern and clinicians are in need of a short, easy-to-use assessment tool for this population. We evaluated the utility and prognostic power of a brief 10-item version of the Beck Depression Inventory (BDI10) in post-MI patients.MethodsPatients (n = 416) were assessed on demographic/clinical variables and completed the BDI10, BDI-21 and STAI (anxiety symptoms) two months post-MI. The end point was a composite of cardiac death and recurrent MI. The average follow-up period was 2.7 years and follow-up data was complete for all patients.ResultsFactor analysis of the BDI10 yielded a one-factor model. The BDI10 had good reliability (α = .82) and correlated highly (r = .89) with the standard BDI measure of depressive symptoms; a BDI-derived proxy measure of the BDI10 correlated .94 with the actual BDI10 score. There were 41 events attributable to cardiac death (n = 24) or recurrent MI (n = 20). The mean level of depressive symptoms as measured by the BDI10 was significantly higher in patients who experienced an event (4.3 ± 4.4) compared with event-free patients (2.6 ± 2.8); p = 0.015. The BDI10 (HR:1.18; 95%CI:1.08–1.29, p < 0.0001) independently predicted death/recurrent MI adjusting for disease severity. Age, BMI and cardiac history were also independent predictors of death/recurrent MI in these analyses.LimitationsThe low number of women (22%), relatively healthy sample (mean LVEF = 52%) and lack of a structured interview as gold standard for assessment of depression.ConclusionsThe BDI10 is a brief, valid, and easy-to-use self-report measure of depressive symptoms that predicts post-MI outcomes and hence can be used clinically for risk stratification purposes, while reducing assessment burden.     

Specifying the effects of physician's communication on patients’ outcomes: A randomised controlled trial

ObjectiveTo experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.MethodsUsing a 2 × 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants’ outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.ResultsPositive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).ConclusionBeing empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients’ outcomes for the best.Practice implicationsContinued medical training is needed to harness placebo-effects of medical communication into practice.     

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded,randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students.MethodsAll students of the first clinical treatment course (n = 46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically.ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p < 0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p > 0.05).ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students.Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.     

Guided self-determination improves life skills with Type 1 diabetes and A1C in randomized controlled trial

ObjectiveTo report 1-year results of newly developed method, guided self-determination (GSD), applied in group training (GSD-GT) for Type 1 diabetes patients with persistent poor glycaemic control.MethodsGSD was designed on the basis of qualitative research to help patients develop life skills with diabetes using worksheets filled in at home and coached by nurses in mutual reflection. We randomized 18–49-year-old adults at a Danish university hospital to either 16 h GSD-GT in 2001 or to similar training 1 year later. Inclusion criteria: mean A1C ≥ 8.0% for at least 2 years, disease onset ≤40 years and insulin treatment from onset.ResultsThirty GSD-GT patients and 20 controls completed the study. GSD-GT patients did better than control patients in terms of (a) increased autonomy support perceived from health professionals (p < 0.01); (b) higher frequency of self-monitored blood glucoses (p < 0.001); (c) increased perceived competence in managing diabetes (p < 0.01); (d) fewer diabetes-related problems (p < 0.05); and (e) improved glycaemic control (p < 0.01).ConclusionGSD was effective in improving life skills with diabetes, including A1C, over a period of 1 year.Practice implicationsGSD is a worthy candidate for further research. We consider it adjustable to people with type 2 diabetes and other chronic conditions.     

The effect of multimedia-based education on students’ anger management skill

IntroductionAnger leads to behaviors that cause a lot of damage. Life skills training can be effective in controlling anger because anger is due to a lack of skills and unpredictability of the situation. The present study aimed to determine the effect of multimedia-based education on students’ anger management skill.Material and methodsThe quasi-experimental study was performed on 88 students of Anesthesiology, Nursing, Midwifery and Operating Room of North Khorasan Nursing and Midwifery School. The educational content was screened through the monitor in front of the main hall of the Nursing & Midwifery School during the students’ attendance for one week. Students’ anger control skills were assessed by tests paired T-test, independent T-test and one-way ANOVA. Data were analyzed using spss16 software.ResultsThe mean age of the students was 20 ± 2.3. Regarding the effect of multimedia-based education on students’ anger control skills, the mean of anger control score was 24.61 ± 2.83 (Min = 11 and Max = 33) before the intervention, and 28.64 ± 2.40 after the intervention. There was a significant difference in mean scores before and after the intervention (P = .000).ConclusionMultimedia-based education has been effective in controlling students’ anger. Given the effect of multimedia-based education on anger control skills, this approach can be used to teach other essential topics to students, including life skills, especially in health science students.     

Implementing a bar-code assisted medication administration system: Effects on the dispensing process and user perceptions

PurposeWe assessed the effects of a bar-code assisted medication administration system used without the support of computerised prescribing (stand-alone BCMA), on the dispensing process and its users.MethodsThe stand-alone BCMA system was implemented in one ward of a teaching hospital. The number of dispensing steps, dispensing time and potential dispensing errors (PDEs) were directly observed one month before and eight months after the intervention. Attitudes of pharmacy and nursing staff were assessed using a questionnaire (Likert scale) and interviews.ResultsAmong 1291 and 471 drug items observed before and after the introduction of the technology respectively, the number of dispensing steps increased from five to eight and time (standard deviation) to dispense one drug item by one staff personnel increased from 0.8 (0.09) to 1.5 (0.12) min. Among 2828 and 471 drug items observed before and after the intervention respectively, the number of PDEs increased significantly (P < 0.001). ‘Procedural errors’ and ‘missing drug items’ were the frequently observed PDEs in the after study. ‘Perceived usefulness’ and ‘job relevance’ of the technology decreased significantly (P = 0.003 and P = 0.004 respectively) among users who participated in the before (N = 16) and after (N = 16) questionnaires surveys. Among the interviewees, pharmacy staff felt that the system offered less benefit to the dispensing process (9/16). Nursing staff perceived the system as useful in improving the accuracy of drug administration (7/10).ConclusionImplementing a stand-alone BCMA system may slow down and complicate the dispensing process. Nursing staff believe the stand-alone BCMA system could improve the drug administration process but pharmacy staff believes the technology would be more helpful if supported by computerised prescribing. However, periodical assessments are needed to identify weaknesses in the process after implementation, and all users should be educated on the benefits of using this technology.     

L’âge des culots globulaires transfusés influence-t-il toujours le pronostic des patients en réanimation ?

ObjectiveFew studies have shown that aged packed red blood cells (RBC) transfusion negatively influenced the outcome of ICU patients, probably related to storage lesions which could be decreased by leukodepletion of RBC. The purpose of this study was to evaluate the impact of aged leukodepleted-RBC pack, on the outcome of ICU patients.DesignRetrospective, observational, cohort study in a Medical Intensive Care Unit.PatientsConsecutive patients admitted during the years 2005 and 2006, and requiring a transfusion. We recorded patient's demographic data, number of RBC unit and age of each RBC, length of ICU, mortality during ICU stay.ResultsFive hundred and thirty-four patients were included with global mortality was 26.6%, length of stay in ICU six days (3–14) and SAPS II 48 (35–62). RBC equaling to 5.9 were transfused per patients (22.7% < 14 days and 57.3% < 21 days). The number of RBC was significantly higher in the dead patients group, but the rate of RBC stored less than 21 days was not different (54% versus 60%; p = 0.21). In a multivariate logistic model, independent predictors of ICU death were SAPS II (OR = 1.02 per point, p < 0.001), number of RBC (OR = 1.08 per RBC, p < 0.001), length of stay in ICU (p < 0.001). Similar results were obtained while introducing the age of RBC as time dependent covariates in a multivariate Cox's model.ConclusionsRBC transfused in our ICU are old. The ICU outcome is independently associated with the number of leucodepleted RBC transfused, but not with their age.     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

ObjectivesThis study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.MethodsWe use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.ResultsResults show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.ConclusionThese results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.Practice implicationsWe therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Take the HEAT: A pilot study on improving communication with angry families

ObjectiveOur objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents’ skills in employing this method.Methods33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.ResultsAfter the workshop, residents’ Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z = −3.428, p < 0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.ConclusionFirst-year pediatric trainees’ communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.Practice implicationsThis study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.     

The first picture archiving and communication system in Lao People’s Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation

BackgroundImplementation of the Picture Archiving and Communication System (PACS) is more challenging in developing countries than in developed countries. Given that the first PACS in Lao People’s Democratic Republic (PDR) was successfully installed at the Children’s Hospital of Lao PDR, we aimed to investigate whether the utilization rate of imaging tests increased after PACS implementation.MethodsPACS was implemented at the Children’s Hospital of Lao PDR in December 2014. We compared the utilization rates of imaging tests including X-ray and ultrasound examinations between the pre-PACS period (from December 2013 to November 2014) and the post-PACS period (from December 2014 to November 2015). The utilization rate was defined as the number of imaging tests divided by the number of patients per month.ResultsThe average number of total imaging tests was 225.8/month (standard deviation [SD], 37.7) during the 1-year pre-PACS period and was 269.4/month (SD, 38.5) during the 1-year post-PACS period (P = 0.0103). The utilization rate of total imaging tests significantly increased after PACS implementation (pre-PACS, 2.47%/month; post-PACS, 4.23%/month; P < 0.0001). Increased utilization rates were observed for both X-rays (pre-PACS, 1.65%/month; post-PACS, 2.38%/month; P = 0.0004) and ultrasound examinations (pre-PACS, 0.82%/month; post-PACS, 1.85%/month; P = 0.0001).ConclusionsThe implementation of PACS at the Children’s Hospital of Lao PDR resulted in a significant increase in the utilization rate of imaging tests, suggesting the indirect benefit of improved quality of care. Our findings showed that the benefits of PACS can be realized even in a resource-limited country such as Lao PDR.     

Does body mass index affect the outcome of unicompartmental knee replacement?

BackgroundObesity is considered to be a contraindication for unicompartmental knee replacement (UKR). The aim was to study the impact of BMI on failure rate and clinical outcome of the Oxford mobile bearing UKR.MethodTwo thousand four hundred and thirty-eight medial Oxford UKRs were studied prospectively and divided into groups: BMI < 25 (n = 378), BMI 25 to < 30 (n = 856), BMI 30 to < 35 (n = 712), BMI 35 to < 40 (n = 286), and BMI 40 to < 45 (n = 126) and BMI ≥ 45 (n = 80).ResultsThere was no significant difference in survival rate between groups. At a mean follow-up of 5 years (range 1–12 years) there was no significant difference in the Objective American Knee Society Score between groups. There was a significant (p < 0.01) trend with the Oxford Knee Score (OKS) and Functional American Knee Society Scores decreasing with increasing BMI. As there was an opposite trend (p < 0.01) in pre-operative OKS, the change in OKS increased with increasing BMI (p = 0.048). The mean age at surgery was significantly (p < 0.01) lower in patients with higher BMI.ConclusionsIncreasing BMI was not associated with an increasing failure rate. It was also not associated with a decreasing benefit from the operation. Therefore, a high BMI should not be considered a contra-indication to mobile bearing UKR.Level of evidenceIV     

Persistence of varicella-zoster virus viraemia in patients with herpes zoster

BackgroundHerpes zoster is caused by the reactivation of varicella-zoster virus from sensory neurons. The commonest complication following zoster is chronic pain termed post herpetic neuralgia.ObjectivesTo investigate the dynamics of VZV viraemia and viral load following the resolution of zoster and its relationship to PHN development.Study designBlood samples were collected at baseline, 1 month, 3 months and 6 month from a prospective study of 63 patients with active zoster. Quantification of VZV DNA in whole blood was performed using a real-time PCR assay.ResultsDuring acute zoster, all patients had detectable VZV DNA in their blood. VZV DNA remained detectable in the blood of 91% of patients at 6 months although levels declined significantly (p < 0.0001). A history of prodromal symptoms (p = 0.005) and severity of pain at baseline (p = 0.038) as well as taking antivirals (p = 0.046) and being immunocompromised (p = 0.043) were associated, with longer time to recovery from PHN. Viral DNA loads were consistently higher in patients with risk factors for PHN and higher viral DNA loads over time were associated with longer time to recovery (p = 0.058 overall and 0.038 in immunocompetent).ConclusionsBased on these observations we hypothesise that VZV replication persists following acute shingles and that higher viral DNA loads contribute to the risk factors for PHN.     

Incremento de síndrome de burnout en estudiantes de Medicina tras su primer mes de rotación clínica

IntroductionIt has been demonstrated that the development of burnout in physicians begins during their academic training and it can affect their personal life.ObjectiveTo evaluate the prevalence of burnout in medical students at the beginning, and after one month of clinical rotation.Materials and methodsWe evaluated students at the beginning of surgical clinical rotation and one month after using the Maslach Burnout Inventory-Human Services Survey. The prevalence and differences between the 2 measurements were calculated.ResultsTwenty-one (12.3%) students showed symptoms of severity at the beginning, and 34 (19.8%) after the first month (P = .059). After eliminating the personal accomplishment scale, 54 (31.6%) and 76 (44.2%) students had severity of symptoms in the rest of the dimensions at the beginning and after one month, respectively (P = .016).ConclusionMedical students showed an increase in the presence of severe burnout, as well as emotional exhaustion and depersonalisation after one month of clinical rotation.     

Predictors of Internet use for health information among male and female Internet users: Findings from the 2009 Taiwan National Health Interview Survey

BackgroundThe Internet is an increasingly important source of health information for the general population. Both preventive health behavior and Internet use are known to be different between men and women. However, few studies have compared predictors of Internet use for health information between the sexes.ObjectivesTo investigate the prevalence and predictors of Internet use for health information among male and female adult Internet users using data from a population-based survey in Taiwan.MethodsRespondents between the ages of 20–65 years were identified from the dataset of the 2009 Taiwan National Health Interview Survey. The outcome variable of the study, the utilization of the Internet for health information, was ascertained by asking whether the respondent had ever used the Internet to search for health information or obtain health services. Univariate and multivariate logistic regression analyses were conducted separately for men and women to evaluate factors associated with the use of Internet for health information.ResultsOf the 2741 adults aged 20–65 years who had ever used the Internet, 1766 (64.4%) of them had used it for health information or services. Multivariate logistic regression analyses showed that a higher educational level (adjusted odds ratio [AOR] = 3.60, P < 0.001), living alone (AOR = 1.77, P = 0.019), had exercised in the past two weeks (AOR = 2.41, P < 0.001), residing in city or urban district (AOR = 1.28, P = 0.049), with a perceived health status of extremely good, very good, or good (AOR = 1.34, P = 0.022), and had used Western medicine services in the past month (AOR = 1.51, P = 0.005) were significantly associated with health information use in male Internet users. On the other hand, age between 20–44.9 years (AOR = 1.87, P < 0.001), a higher educational level (AOR = 3.57, P < 0.001), being married (AOR = 1.68, P = 0.001), had exercised in the past two weeks (AOR = 1.56, P < 0.001), and had a mean monthly personal income of NT$ 20,000 and above were significant factors in female Internet users.ConclusionsThis secondary data analysis of a representative sample of Taiwan population revealed that a similar but not identical set of independent factors was associated with the use of Internet for health information between male and female Internet users.     

Kinetics of the electrocardiographic changes after permanent coronary occlusion in rats: Relationship with infarct size

The electrocardiogram (ECG) has been a useful tool to identify ischemia in humans and laboratory animals. Previous ECG studies showed that presence of pathological Q waves in lead DI in rats submitted to ligature of the left coronary artery (LCA) is a good predictor of successful myocardial infarction (MI). This study aimed to determine the sensitivity and the specificity of these ECG findings to predict successful MI. Male Wistar rats were submitted to surgical ligature of the LCA (N = 86) or sham-operation (SO, N = 16). ECG was recorded under halothane/ether anesthesia before surgery and 1, 3, 5, 7, and 15 days later. MI was determined by the presence of a transmural fibrous scar. Sixty-nine rats survived and 60 showed fibrous scar indicating a successful production of MI (18 and 42 animals were analyzed 1 or 15 days after MI, respectively). Twenty-four hours after, Q amplitude was linearly related to infarct size (r = ?0.778; P < 0.01), but not 15 days after (r = ?0.416; P > 0.05). In 53 out of 60 rats with transmural scar, Q wave in lead DI was identified in the ECG. Absence of Q wave occurred in 7 animals. The sensitivity was 88% (CI₉₅ = 83–93%). Nine animals submitted to coronary ligature did not show infarct scar. One of these animals, however, showed Q wave in DI, indicating a specificity of 77% (CI₉₅ = 65–104%). In conclusion, ECG can be used as a reliable tool to identify MI and can be used to predict the infarct size as earlier as 1 day after LCA ligation in rats.     

Detecting the effects of physician training in self-care interviewing skills: Coding of standardized patient (SP) visit recordings versus SP post-visit ratings

ObjectiveTo compare how coder ratings of standardized patient (SP) visit recordings and SP ratings of the visits detect primary care physician (PCP) training in self-efficacy enhancing interviewing techniques (SEE IT).MethodsAnalyses of data from 50 PCPs who participated in a randomized controlled trial of SEE IT training, which led to increased SEE IT use during three SP visits 1–3 months post-intervention. Untrained SPs rated SEE IT use post-visit. Subsequently, three trained coders generated a consensus SEE IT rating from visit audio recordings. SPs and coders were blinded to provider study arm, and coders to SP ratings.ResultsSP and coder ratings were correlated (r = 0.62). In detecting the intervention effect, the areas under the receiver operating characteristic curve were 0.80 (95% CI 0.74–0.87) and 0.76 (95% CI 0.69–0.84) for consensus coder and SP ratings, respectively (difference 0.04, 95% CI −0.04–0.11; z = 1.04, p = 0.30).ConclusionSP ratings were not significantly different from coder ratings of SP visit recordings in detecting PCP SEE IT training.Practice implicationsIf similar findings are observed in larger studies, it would suggest a greater role for SP ratings in detecting provider interviewing skills training, given the relative simplicity, low cost, and non-intrusiveness of the approach.     

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms

ObjectiveTo assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms.Study designA purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage.Main outcome measuresNon-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage.Results39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p = 0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r = 0.69, p < 0.001, n = 39).ConclusionOverall website quality and information coverage are poor and the required reading level high.