Impacts Of Average Reading Level On Care

Hello, Summarians!

How do we best communicate with each other? This can be a challenging question. It involves natural abilities and learned skills. It also depends on the form of communication used and the preferences of both parties.

The potential for failure is high, so it is essential to utilize any known methods for improvement.

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Changing Needles For Injections

This study addressed the long-standing but largely anecdotal practice of replacing needles after puncturing a vaccine vial septum prior to subcutaneous vaccination in dogs. Although most veterinary professionals routinely replace needles, citing concerns about dulling, patient discomfort, and perceived ease of injection, objective evidence to support this practice has been lacking. In a randomized, double-blinded, controlled crossover trial, the investigators found no difference in canine comfort when vaccines were administered with replaced versus nonreplaced needles, as measured by peak heart rate responses and observed reaction scores. Injectors were also unable to reliably distinguish between replaced and non-replaced needles based on perceived ease of skin puncture, with guessing no better than chance. These in vivo findings build on prior in vitro data showing only a small increase in penetration force after a single septum puncture and demonstrate that such changes do not translate into clinically meaningful differences in animal response. 

Secondary analyses suggested that factors such as vaccine type, injection site, and order of administration may influence stress responses more than needle replacement, with a possible additive effect when rabies vaccines were administered in the rear limb as the second injection. Reaction scores aligned with heart rate findings, further supporting the conclusion that needle replacement does not improve the vaccination experience. The results are consistent with the broader human medical literature, in which randomized trials and systematic reviews have generally failed to show meaningful reductions in pain, tissue damage, or adverse reactions when needles are changed after vial puncture. 

Importantly, the study highlights that routine needle replacement is not a neutral practice: it increases occupational risk from needlestick injuries, raises costs, and contributes substantially to regulated medical waste without demonstrable benefit to patients. Although limited to a single needle gauge and brand and to dogs with low to moderate fear, anxiety, and stress scores, the trial provides the first direct in vivo evidence in veterinary medicine that replacing needles after a single vial septum puncture confers no measurable advantage during subcutaneous vaccination. Taken together, the available evidence suggests that routine needle replacement before SC vaccination in dogs is unnecessary and should not be considered standard practice. 

Sagaser, J., Jones, J., Baird, M., Statton, D., & Kreisler, R. E. (2025). Needle replacement before subcutaneous vaccination in dogs: a randomized clinical trial finds no clinical benefit. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.25.10.0661

Bottom line — No clinical benefit noted.

Sham Surgeries and Pain

This randomized sham-controlled trial investigated outcomes of minimally invasive sacroiliac (SI) joint fusion compared with sham surgery in patients with chronic SI joint pain, using both subjective pain reports and objective measures, including quantitative sensory testing (QST) and resting-state functional MRI (rsfMRI). Both the fusion and sham groups demonstrated meaningful improvements from baseline to follow-up, while a small nonrandomized observational group showed no improvement, suggesting that spontaneous remission was unlikely and that placebo-related mechanisms accounted for a substantial portion of the observed benefit. Although the fusion group reported lower weekly average pain at follow-up, this difference was largely driven by a few super-responders, and SI joint–specific pain ratings did not significantly differ between groups. Experimental pain testing did not clearly separate the groups, but pressure pain measures correlated with subjective pain ratings, linking perceived improvement to experimental outcomes. Baseline variability in clinical pain predicted pressure pain outcomes in the sham group but not in the fusion group, suggesting that endogenous pain regulation and placebo responsiveness may have contributed more strongly to improvement after sham surgery, whereas reduced nociceptive input may have played an additional role in the fusion group. Exploratory rsfMRI analyses indicated differential changes in brain connectivity, with decreased coupling between primary somatosensory cortex and the default mode network in the fusion group, consistent with prior findings in chronic pain treatment, although these results did not survive correction for multiple comparisons. Treatment response was highly heterogeneous, and responders in the fusion group tended to have higher preoperative expectations of benefit and more severe baseline symptoms, highlighting the potential importance of expectancy effects in surgical outcomes. Limitations include small sample size, lack of randomization in the observational group, possible confounding from opioid use, and limited generalizability due to a predominantly female sample, underscoring the need for larger, rigorously controlled studies to clarify mechanisms underlying surgical and placebo responses in chronic SI joint pain. 

Pontén, Moa^a; Thompson, William H.^a,b; Blomé, Sebastian^a; Vadenmark, Viktor^a; Kaptchuk, Ted J.^c; Gerdhem, Paul^d,e,f; Lalouni, Maria^a; Jensen, Karin^a,*. Comparing genuine and sham surgery for sacroiliac joint pain using self-assessments, pain testing, and neuroimaging. PAIN Reports 10(6):e1340, December 2025. | DOI: 10.1097/PR9.0000000000001340 

Bottom line — Helping to understand the placebo effect.

Reading Levels And Health Literacy

The present study evaluated online resources related to CCLR management and postoperative recovery and found that all materials were written well above recommended readability levels. Rehabilitation instructions typically exceeded a seventh-grade level, while CCLR management materials were written above a ninth-grade level, with most documents falling between the 10th and 12th grades. None of the evaluated materials met AMA recommendations. These findings mirror prior veterinary and human medical studies, which consistently show that patient education materials have remained overly complex for decades. 

Low health literacy in human medicine has been linked to misunderstandings, missed follow-up care, increased emergency visits, and poorer health outcomes. Comparable consequences are likely in veterinary medicine, where misunderstanding of medical instructions can contribute to poor treatment adherence, complications, and repeat hospital visits. Evidence from human healthcare demonstrates that simplifying educational materials improves comprehension, adherence, and outcomes, suggesting similar benefits could be achieved for pet owners and their animals. 

Improving readability in veterinary medicine would require assuming no medical background, using simple vocabulary and short sentences, eliminating jargon, incorporating visual aids, and ensuring cultural relevance. Materials should be reviewed by pet owners or assessed using readability tools before publication, and veterinarians should be trained in plain-language communication and employ strategies such as teach-back during consultations. Although the study had limitations related to sample size and potential biases inherent to search engine–based sampling, the strong effects observed support the conclusions. 

Overall, reducing the readability gap in veterinary medical communication represents an important opportunity to enhance client understanding, strengthen veterinarian-client relationships, and improve animal welfare. While readability alone cannot address all challenges in veterinary care, prioritizing clear and accessible language is a meaningful step toward more effective and equitable veterinary communication. 

Kanarsky, A. M., Levine, D., Marcellin-Little, D. J., & Garcia, T. C. (2025). Online information for dog owners regarding cranial cruciate ligament injury and recovery does not meet health literacy recommendations. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.25.10.0680

Bottom line — We need to be aware of how we communicate to improve comprehension.

Just putting things in perspective …