The Journal of the Royal College of Physicians of Edinburgh

Fitzsimmons, PR; Michael, BD; Hulley, JL; Scott, GO

doi: 10.4997/jrcpe.2010.401pmid: 21132132

Background: Patients increasingly use the internet to access health information.Inadequate health literacy is common and frequently limits patient comprehension of healthcare literature. We aimed to assess the readability of online consumerorientated Parkinson’s disease (PD) information using two validated measures.Method: We identified the 100 highest ranked consumer-orientated PD webpages and determined webpage readability using the Flesch-Kincaid and Simple Measure Of Gobbledygook (SMOG) formulae.Results: None of the webpages analysed complied with current readability guidelines. Commercial websites were significantly easier to read (p=0.035). The Flesch-Kincaid formula significantly underestimated reading difficulty (p<0.0001). Ease of reading correlated weakly with search engine ranking (r=0.35, p=0.0004).Conclusions: Only 1% of the top 100 PD information webpages are fully comprehensible to the average adult. Simple Measure Of Gobbledygook should be the preferred measure of webpage readability. Parkinson’s disease information websites require major text revision to comply with readability guidelines and to be comprehensible to the average patient.

Patterson, ML

doi: 10.4997/jrcpe.2010.415pmid: N/A

doi: 10.4997/jrcpe.2010.422pmid: N/A

doi: 10.1177/1478271520104004025pmid: N/A

doi: 10.1177/1478271520104004028pmid: N/A

doi: 10.1177/1478271520104004008pmid: N/A

Polk, JD

doi: 10.4997/jrcpe.2010.413pmid: 21132131

Crompton, GK

doi: 10.4997/jrcpe.2010.402pmid: 21132133

The observation that hyperventilation was common in men involved in civil court actions compared with my non-medico-legal practice stimulated me to carefully assess 100 consecutively seen men with non-malignant asbestosrelated disease(s). A diagnosis of hyperventilation was made in 33 and probable hyperventilation in 12. The development of anxiety symptoms in these men could, in part at least, be prevented or greatly decreased if more emphasis was placed on the education of ex-asbestos workers by solicitors and organisations responsible for the initiation of civil actions.

Peeroo, K; Clark, A

doi: 10.4997/jrcpe.2010.403pmid: 21132134

The prevalence of proteinuria in patients presenting acutely with oedema due to heart failure has not been studied extensively. Recent evidence from the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) trial suggests that there is a high prevalence of albuminuria in chronic heart failure patients. We set out to investigate the prevalence of proteinuria in patients presenting with fluid retention secondary to heart failure. A random collection of urine albumin–creatinine ratios (ACRs) in successive patients was used to quantify proteinuria. Out of a sample of 19 patients, seven had no detectable albuminuria, eight had microalbuminuria and four had macroalbuminuria. We did not find any relation between urine ACR and age, serum urea or serum creatinine. Moreover, we did not find a higher prevalence of albuminuria with increasing age or the presence of diabetes mellitus. In conclusion, the clinical significance of this common finding in patients presenting with fluid retention is not clear, and further research is warranted to clarify its prognostic value.

Newton, JL; Mabillard, H; Scott, A; Hoad, A; Spickett, G

doi: 10.4997/jrcpe.2010.404pmid: 21132135

In England the Department of Health has funded specialist clinical services aimed at diagnosing and managing the symptoms of chronic fatigue syndrome (CFS). These services are not available to those who do not fulfil the diagnostic criteria for CFS. This service evaluation examined the proportion of those referred to a specialist CFS service fulfilling the Fukuda diagnostic criteria for CFS and the alternative fatigue-associated diagnoses. The CFS database was interrogated to include every patient referred to the Newcastle service from November 2008 to December 2009. All medical notes were reviewed and the diagnosis, sex and age recorded. Data were compared to a previous service evaluation (2005–07). In 2008–09, 260 subjects were referred: 19 referrals per month (260/14), compared with 17 referrals per month in 2005–07 (375/24). The proportion of patients diagnosed with CFS increased significantly compared with 2007 (36% [20/56] vs 60% [157/260]; p<0.0001). Of the 40% of patients subsequently found not to have CFS the most common diagnosis was fatigue associated with a chronic disease (47% of all alternative diagnoses); 20% had primary sleep disorders, 15% psychological/psychiatric illnesses and 4% a cardiovascular disorder. Thirteen per cent remained unexplained (5.2% of the total referrals). This study found a significant increase in the proportion of patients referred to National Health Service (NHS) CFS services diagnosed with CFS. A large proportion of patients presenting with fatigue are not eligible for referral to the Department of Health specialist fatigue services, which represents an unmet need in terms of symptom management in current NHS services.