title: Assessment of the quality of Internet information on sleeve gastrectomy.
abstract: BACKGROUND
  The Internet is an important source of information for morbidly obese patients who are potential candidates for bariatric procedures. Over the past few years, there is growing demand for sleeve gastrectomy because of perceived technical ease balanced with excellent outcomes. The aim of this study was to assess the quality and content of available internet information pertaining to sleeve gastrectomy. Our hypothesis is that this information is inconsistent and inaccurate.
  
  
  METHODS
  A total of 50 websites were analyzed in September 2013. We used the search term "sleeve gastrectomy" to identify sites on the most common internet search engines: Google, Yahoo, Bing, and Ask. Based on popularity of use, 20 websites were obtained through the Google engine and 10 sites by each of the others. Websites were classified as academic, physician, health professional, commercial, social media, and unspecified. Quality of information was evaluated using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Health on the Net code (HONcode) seal accreditation. The DISCERN score varies from 0-80 points and is based on 16 questions that evaluate publication quality and reliability. The JAMA benchmark criteria range from 0-4 points assessing website authorship, attribution, disclosure, and currency. HONcode certification was assessed as present or absent website accreditation. Duplicate and inaccessible websites were excluded from the analysis.
  
  
  RESULTS
  We identified 43 websites from the United States, 6 from Mexico, and 1 from Australia. The average DISCERN and JAMA benchmark scores for all websites were 46.3±14.5 and 1.6±1.1, respectively, with a median DISCERN of 48.5 (range, 16-76) and JAMA score of 2.0 (range, 0-4). Website classification distribution was 21 physician, 11 academic, 7 commercial, 5 social media, 4 unspecified, and 2 health professional. The average DISCERN and JAMA benchmark scores were 55.4±13.4 and 2.4±1.0 in the academic group, 49.5±10.0 and 1.9±.9 in the physician group, 46.9±14.2 and .2±.4 in social media sites, 44.0±2.8 and 1.0±.0 in health professional pages, 41.3±14.2 and 1.0±1.0 in commercial sites, and 39.8±19.5 and 1.0±1.1 in the unspecified group. The HONcode seal was present in 2 (4%) of the websites analyzed.
  
  
  CONCLUSIONS
  The results of this study suggest poor quality and content of information on the internet viewed by potential bariatric candidates. Only 4% of the websites demonstrated HONcode seal accreditation. The global mean DISCERN and JAMA benchmark scores reported in this study were significantly lower than one would expect. Academic and physician websites offer the best information content whereas the worst was observed in the commercial and unspecified groups.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Ohio; Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Ohio.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Ohio.
authors.forename: Hector Romero
authors.initials: HR
authors.lastname: Talamas
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Ohio. Electronic address: BRETHAS@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet / Q000592:standards*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: bariatric; internet; quality; sleeve gastrectomy