Adam Korrick Lewkowitz

Background: Iron deficiency is the most common micronutrient deficiency and, when untreated, progresses to anemia. Existing guidance on the diagnostic criteria for iron deficiency is limited and not evidence based. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the diagnosis of iron deficiency, taking a global perspective in all settings. Methods: ASH established a multidisciplinary guideline panel that included 1 patient representative and was balanced to minimize potential bias from conflicts of interest. The University of Kansas Health System supported the guideline-development process, including performing systematic evidence reviews on the prevalence of iron deficiency across populations and studies to inform diagnostic thresholds up to July 2025. The panel prioritized clinical questions according to clinical impact and high-risk populations. The panel used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subsequently open for public comment. Results: The panel agreed on 5 recommendations. Conclusions: Key recommendations of these guidelines include serum ferritin thresholds for specific populations, with the goal to prioritize the diagnosis of iron deficiency, irrespective of the presence of anemia, remarks for considerations of other diagnostic thresholds, and guidance on the diagnosis of iron deficiency in persons with inflammation. Gaps in the literature and research priorities were also identified.

Introduction: In obstetrics, patients with insufficient health literacy have a higher likelihood of adverse perinatal outcomes. The American Medical Association (AMA) recommends all patient‐facing health information be written at or below a sixth‐grade reading level. The reading level of standardized obstetric patient education materials embedded into Epic via “Patient Pass/Exit Care” package published by Elsevier is unknown. Since the Spanish versions of the materials have not been back‐translated, the readability of those materials also requires further assessment. In this study, our aims were to (1) characterize overall readability of Epic's obstetric patient education documents, (2) assess differences in readability between English and Spanish materials, and (3) understand differences in readability by subject material, stratified by language. Methods: Using the “Clinical References” tab in Epic, obstetric patient education materials were extracted in both English and Spanish. Materials were evaluated using metrics for assessing readability that have been validated in English and/or Spanish: Flesch–Kincaid Grade Level (FKGL), Fernandez‐Heurta (FH), and Simple Measure of Gobbledygook (SMOG). Education was coded by content category. Paired t ‐tests were conducted to evaluate differences in readability scores (FKGL vs. FH) and SMOG scores across language pairs. Mean differences (95% confidence intervals [CIs]) and one‐way ANOVA with Bonferroni‐adjusted post hoc tests assessed language readability gaps across clinical categories. Results: Of 235 total texts analyzed, grade level for English was 6.2 (SD 1.0) using the FKGL metric versus 4.2 (SD 0.5) for Spanish content that used the validated FH. Overall, the English documents were 2.0 grade levels higher than the corresponding Spanish documents (95% CI, 1.8–2.1). SMOG mean grade level for English materials was 9.7 (SD 0.9) versus 6.2 (SD 0.6) for Spanish materials ( p < 0.01). Across all perinatal topics, English texts scored significantly higher than Spanish texts on both SMOG and language‐specific readability metrics. A total of 41.2% of Spanish materials were at or below a 6th grade level using SMOG, but none of the English materials were. Conclusion: Existing obstetric patient education materials embedded in the Epic electronic medical record (EMR) do not meet AMA standards for readability and comprehension. Differences between English and Spanish materials highlight a potential for disparities in patient understanding of their plans of care.

Among newly postpartum people, the novel Just Breathe guided breathing device showed high user satisfaction scores and self-perceived reductions in stress, although the Cohen d effect on heart rate variability and stress or anxiety symptoms as measured by validated psychometric scales was minimal.