Publications by authors named "Nicole Leigh Aaronson"

8 Publications

  • Page 1 of 1

Improving Attendance and Patient Experiences During the Expansion of a Telehealth-Based Pediatric Otolaryngology Practice.

Otolaryngol Head Neck Surg 2021 05 20;164(5):952-958. Epub 2020 Oct 20.

Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.

Objective: To determine the rates and primary causes of missed appointments (MAs) for telehealth visits and present remedies for improvement.

Methods: This cross-sectional survey was conducted at a tertiary care pediatric otolaryngology practice during expansion of telehealth-based visits. A review of questionnaire responses was performed for 103 consecutive patients with MAs over 50 business days from March 20, 2020, to May 29, 2020. Families were asked a brief survey regarding the cause of the MA and assisted with technical support and rescheduling. MA rates and causes were analyzed.

Results: The overall MA rate during the initiation of telehealth services was significantly increased at 12.4% as compared with clinic-based visits of a similar duration before COVID of 5.2% ( < .001). Technical issues were the most common causes of MAs (51.3%). Of the caregivers, 23.8% forgot or reported cancellation of the appointment. Five percent of patients were non-English speaking and scheduled without translator support. Minorities and patients with public insurance represented 53.6% and 61.9% of MAs, respectively.

Discussion: Technical difficulties were the most commonly reported cause of missed telehealth appointments. Optimization of applications by providing patient reminders, determining need for translator assistance, and reducing required upload/download speeds may significantly reduce rates of MAs and conversions to other communication.

Implications For Practice: Clear, concise education materials on the technical aspects of telehealth, platform optimization, and robust technical and administrative support may be necessary to reduced missed telehealth appointments and support large-scale telehealth operations. An assessment of institutional capacity is critical when considering telehealth expansion.
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http://dx.doi.org/10.1177/0194599820965917DOI Listing
May 2021

Bilateral Posterior Neck Masses in an 8-Year-Old Boy: A Case of Pediatric Tularemia of the Head and Neck.

Ear Nose Throat J 2021 Nov 8;100(9):631-633. Epub 2020 May 8.

Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA.

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http://dx.doi.org/10.1177/0145561320923830DOI Listing
November 2021

Quality of Patient Education Sections on Otitis Media Across Different Website Platforms.

Ann Otol Rhinol Laryngol 2020 Jun 24;129(6):591-598. Epub 2020 Jan 24.

Department of Surgery, Section of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.

Objective: To determine the quality, content, and readability of patient education materials pertaining to otitis media across several popular online platforms focused on otolaryngology and pediatric primary care education.

Methods: Online patient materials related to otitis media and directed toward parents were collected from the American Association for Family Practice (AAFP), ENT-Health section of the American Academy of Otolaryngology-Head and Neck Surgery, Healthychildren.org from the American Academy of Pediatrics, KidsHealth from Nemours, WebMD, and Wikipedia. Materials were analyzed for quality, content, and readability. The DISCERN instrument was used to score quality. A unique content score was generated based on the information provided on each website and on the medical and surgical management of otitis media. Readability scores were calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, and Automated Readability Index.

Results: Overall, content was well-balanced. Information from AAFP and Healthychildren.org was focused more on medical management than other sources. The average DISCERN scores showed all sources to be of good quality with minimal shortcomings. The AAFP and KidsHealth websites had some readability scores around the 8th-grade reading level, the National Institute of Health's upper limit recommended for public health information; however, most websites were above this recommended reading level.

Conclusion: Patient education materials related to otitis media on academic and certain popular internet sites are good sources to obtain high-quality information on the topic. Patient educational background, prior knowledge and understanding of otitis media, and physician-patient partnership goals should be taken into account when referring patients to online materials.
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http://dx.doi.org/10.1177/0003489420902183DOI Listing
June 2020

Parental health literacy in pediatric otolaryngology: A pilot study.

Int J Pediatr Otorhinolaryngol 2019 Oct 28;125:87-91. Epub 2019 Jun 28.

Johns Hopkins University Departments of Otolaryngology and Health Policy & Management, Baltimore, MD, USA. Electronic address:

Objectives: Pediatric otolaryngology bears the highest frequency of elective surgical cases in children, but little is known regarding the health literacy of these children's parents. In a questionnaire-based pilot study, we assessed parental health literacy in our pediatric otolaryngology clinic and evaluated its relation to personal demographics. We also evaluated postoperative and diagnosis-based leaflets for readability using validated measures.

Methods: Parents completed the Short Assessment of Health Literacy-English (SAHL-E) and were defined as low (0-14) or high (>14) literacy based on mean scores.

Results: Fifty parents participated (mean SAHL-E score, 17.6), and all scored >14, indicating proficient health literacy. No differences existed in mean or median scores based on demographics. Continued education after high school was associated with higher scores (P = 0.003) and was the only significant variable in multivariable linear regression. All leaflets were at or below the recommended reading level for public health information.

Conclusions: Parents generally had high health literacy.
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http://dx.doi.org/10.1016/j.ijporl.2019.06.029DOI Listing
October 2019

Health literacy in pediatric otolaryngology: A scoping review.

Int J Pediatr Otorhinolaryngol 2018 Oct 11;113:252-259. Epub 2018 Aug 11.

Departments of Otolaryngology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA.

Objective: To review research on status and outcomes of health literacy in pediatric otolaryngology and identify opportunities for quality improvement.

Methods: We performed a scoping review, adhering to methodologic standards. A combination of MeSH terms and keywords related to health literacy in otolaryngology was used to conduct a search. Relevant studies were identified using PubMed, Ovid MEDLINE, and Google Scholar databases. Studies were selected for inclusion by two authors if they addressed the domains of pediatric otolaryngology as well as health literacy. Data were abstracted from each study on the number of participants, the setting, the study design, the outcome measure, the intervention used, and the overall theme. Authors identified prominent overarching themes and grouped studies accordingly. Results were then tabulated for further review and to discern implications for future practice and research.

Results: Of 1046 articles identified, 20 articles were included. Studies fell into three major themes: readability of patient materials, patient recall after informed consent, and optimal patient education. Prominent findings included the following: 1. Much of the printed and electronic educational material in otolaryngology is above the recommended reading level for public health information; 2. Parents do not easily recall information provided verbally or in written form; and 3. Adding visual and multimodal components improves the success of parental education.

Conclusion: Health literacy in pediatric otolaryngology may influence comprehension of educational materials and adequacy of informed consent. Future research may address whether patient health literacy affects clinical outcomes.
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http://dx.doi.org/10.1016/j.ijporl.2018.08.013DOI Listing
October 2018

Quality, Readability, and Trends for Websites on Ankyloglossia.

Ann Otol Rhinol Laryngol 2018 Jul 18;127(7):439-444. Epub 2018 May 18.

2 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.

Objective: This study evaluates the quality and readability of websites on ankyloglossia, tongue tie, and frenulectomy.

Methods: Google was queried with six search terms: tongue tie, tongue tie and breastfeeding, tongue tie and frenulectomy, ankyloglossia, ankyloglossia and breastfeeding, and ankyloglossia and frenulectomy. Website quality was assessed using the DISCERN instrument. Readability was evaluated using the Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, and Fry readability formula. Correlations were calculated. Search terms were analyzed for frequency using Google Trends and the NCBI database.

Results: Of the maximum of 80, average DISCERN score for the websites was 65.7 (SD = 9.1, median = 65). Mean score for the Flesch-Kincaid Reading Grade Level was 11.6 (SD = 3.0, median = 10.7). Two websites (10%) were in the optimal range of 6 to 8. Google Trends shows tongue tie searches increasing in frequency, although the NCBI database showed a decreased in tongue tie articles.

Conclusions: Most of the websites on ankyloglossia were of good quality; however, a majority were above the recommended reading level for public health information. Parents increasingly seek information on ankyloglossia online, while fewer investigators are publishing articles on this topic.
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http://dx.doi.org/10.1177/0003489418776343DOI Listing
July 2018

Can telemetry data obviate the need for sleep studies in Pierre Robin Sequence?

Int J Pediatr Otorhinolaryngol 2017 Sep 14;100:238-241. Epub 2017 Jul 14.

Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, United States.

Objective: This study looks to correlate telemetry data gathered on patients with Pierre Robin Sequence (PRS) with sleep study data. Strong correlation might allow obstructive sleep apnea (OSA) to be reasonably predicted without the need for sleep study.

Methods: Charts from forty-six infants with PRS who presented to our children's hospital between 2005 and 2015 and received a polysomnogram (PSG) prior to surgical intervention were retrospectively reviewed. Correlations and scatterplots were used to compare average daily oxygen nadir, overall oxygen nadir, and average number of daily desaturations from telemetry data with apnea-hypopnea index (AHI) and oxygen nadir on sleep study. Results were also categorized into groups of AHI ≥ or <10 and oxygen nadir ≥ or <80% for chi-squared analysis.

Results: Our data did not show significant correlations between telemetry data and sleep study data. Patients with O2 nadir below 80% on telemetry were not more likely to have an O2 nadir below 80% on sleep study. Patients with an average O2 nadir below 80% did show some correlation with having an AHI greater than 10 on sleep study but this relationship did not reach significance. Of 22 patients who did not have any desaturations on telemetry below 80%, 16 (73%) had an AHI >10 on sleep study.

Conclusions: In the workup of infants with PRS, the index of suspicion is high for OSA. In our series, telemetry data was not useful in ruling out severe OSA. Thus our data do not support forgoing sleep study in patients with PRS and concern for OSA despite normal telemetry patterns.
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http://dx.doi.org/10.1016/j.ijporl.2017.07.015DOI Listing
September 2017

Quality and readability of websites for patient information on tonsillectomy and sleep apnea.

Int J Pediatr Otorhinolaryngol 2017 Jul 23;98:1-3. Epub 2017 Apr 23.

Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, United States. Electronic address:

Objectives: Tonsillectomy is a common treatment for obstructive sleep apnea (OSA). The Internet allows patients direct access to medical information. Since information on the Internet is largely unregulated, quality and readability are variable. This study evaluates the quality and readability of the most likely visited websites presenting information on sleep apnea and tonsillectomy.

Methods: The three most popular search engines (Google, Bing, Yahoo) were queried with the phrase "sleep apnea AND tonsillectomy." The DISCERN instrument was used to assess quality of information. Readability was evaluated using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES).

Results: Out of the maximum of 80, the average DISCERN quality score for the websites was 55.1 (SD- 12.3, Median- 60.5). The mean score for FRES was 42.3 (SD- 15.9, Median- 45.5), which falls in the range defined as difficult. No website was above the optimal score of 65. The mean score for the FKGL was US grade-level of 10.7 (SD- 1.6, Median- 11.6). Only 4(27%) websites were in the optimal range of 6-8. There was very weak correlation between FRES and DISCERN (r = 0.07) and FKGL and DISCERN (r = 0.21).

Conclusions: Tonsillectomy is one of the most common surgeries in the US. However, the internet information readily available to patients varies in quality. Additionally, much of the information is above the recommended grade level for comprehension by the public. By being aware of what information patients are reading online, physicians can better explain treatments and address misunderstandings. Physicians may consider using similar methods to test the readability for their own resources for patient education.
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http://dx.doi.org/10.1016/j.ijporl.2017.04.031DOI Listing
July 2017
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