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Background: Consent is an important component of surgical care. Poorly attempted consent bears significant ethical and legal implications. We assessed the effectiveness of handouts in improving postoperative consent understanding and recall compared to standard verbal consent during laparoscopic cholecystectomy as a tool that may improve information retention and leads to better treatment satisfaction.Methods: This is a prospective block randomized, non-blinded study conducted at a single tertiary hospital. Patients undergoing elective laparoscopic cholecystectomy between August 2017 and October 2018 were recruited and randomized into Handout Assisted Consent (HC) and Verbal Consent (VC) group. The HC group was given an adjunct handout on laparoscopic cholecystectomy during consent process in addition to the standard verbal consent. A validated open-ended verbal understanding and recall questionnaire was administered to all patients in both groups at Day 1, 30 and 90 after surgery. Patient satisfaction of the consent process was evaluated with Likert scale.Results: A total of 79 patients were enrolled, 41 patients and 38 patients in VC and HC groups respectively. Level of understanding among patients were equal and consistent across time in both groups (P > 0.05). There was significant decline (P < 0.0001) for both groups in ability to recall information between Day 1 to Day 30 and Day 30 to Day 90. A slightly higher satisfaction rate was found among patients that received HC (P > 0.05).Conclusion: There is good consistent understanding of the surgery in both groups. However, recall of specific surgical consent items decreased significantly over time in both groups. Handouts may have increased satisfaction among patients but did not improve recall in this preliminary study.Trial Registration: MREC No.:201783-5468. [ABSTRACT FROM AUTHOR]

Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia. In no small part, memories are influenced by a patient's interpretations of events in light of their own belief systems. From the practitioner's point of view, relating fully to the patient's experience requires some framework of understanding. The purpose of this review is to highlight research over the previous decades on belief systems and their interactions with autobiographical memory, which organises episodic memories into a personally relevant narrative. As a result, memory is a set of continuously malleable processes, and is best described as a (re)constructive rather than photographic instantiation. Belief systems are separate but closely interacting processes with autobiographical memory. The interaction of a constantly evolving set of memories with belief systems can explain phenomena such as illusions, distortions, and (re)constructions of factitious events. How anaesthetics and our patient interactions influence these behaviours, and vice versa, will be important questions to explore and define with future research. [ABSTRACT FROM AUTHOR]

Background: The identification of the occurrence of falls is an important step for screening and for rehabilitation processes for the elderly. The methods of monitoring these events are susceptible to recording biases, and the choice of the most accurate method remains challenging. Objectives: (i) To investigate the agreement between retrospective self-reporting and prospective monitoring of methods of recording falls, and (ii) to compare the retrospective self-reporting of falls and the prospective monitoring of falls and recurrent falls over a 12-month period among older women at high risk of falls and fractures. Method: A total of 118 community-dwelling older women with low bone density were recruited. The incidence of falls was monitored prospectively in 116 older women (2 losses) via monthly phone calls over the course of a year. At the end of this monitoring period, the older women were asked about their recall of falls in the same 12-month period. The agreement between the two methods was analyzed, and the sensitivity and specificity of self-reported previous falls in relation to the prospective monitoring were calculated. Results: There was moderate agreement between the prospective monitoring and the retrospective self-reporting of falls in classifying fallers (Kappa=0.595) and recurrent fallers (Kappa=0.589). The limits of agreement were 0.35±1 .66 falls. The self-reporting of prior falls had a 67.2% sensitivity and a 94.2% specificity in classifying fallers among older women and a 50% sensitivity and a 98.9% specificity in classifying recurrent fallers. Conclusion: Self-reporting of falls over a 12-month period underestimated 32.8% of falls and 50% of recurrent falls. The findings recommend caution if one is considering replacing monthly monitoring with annual retrospective questioning. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the effects of two health information texts on patient recognition memory, a key aspect of comprehension. Methods: Randomized controlled trial (N =60), comparing the effects of experimental and control colorectal cancer (CRC) screening texts on recognition memory, measured using a statement recognition test, accounting for response bias (score range −0.91 to 5.34). The experimental text had a lower Flesch–Kincaid reading grade level (7.4 versus 9.6), was more focused on addressing screening barriers, and employed more comparative tables than the control text. Results: Recognition memory was higher in the experimental group (2.54 versus 1.09, t =−3.63, P =0.001), including after adjustment for age, education, and health literacy (β =0.42, 95% CI: 0.17, 0.68, P =0.001), and in analyses limited to persons with college degrees (β =0.52, 95% CI: 0.18, 0.86, P =0.004) or no self-reported health literacy problems (β =0.39, 95% CI: 0.07, 0.71, P =0.02). Conclusion: An experimental CRC screening text improved recognition memory, including among patients with high education and self-assessed health literacy. Practice implications: CRC screening texts comparable to our experimental text may be warranted for all screening-eligible patients, if such texts improve screening uptake. [Copyright &y& Elsevier]

Abstract: Introduction: Pain research in emergency settings can be problematic, as data collection is logistically difficult and pain levels are often poorly documented. Short-term recall of acute pain has been evaluated in postoperative, labour and procedural pain, with variable reported accuracy. The reliability of pain recall in trauma resuscitation patients is unknown. This study aims to determine the accuracy of short-term pain recall 1–2days after trauma. Methods: Prospective, cohort study of trauma resuscitation patients transported by ambulance to a major trauma centre. Patients with haemodynamic instability (SBP<90, HR>120) or GCS<14 on arrival were excluded. Momentary pain scores were measured on an 11-point verbal numerical rating scale by paramedics during prehospital management. Patients were evaluated within 48h of injury on the recall of their initial pain, pain during transport, and lowest pain score achieved by prehospital analgesia. Spearman''s rank correlation and Bland–Altman tests were used to compare ambulance and hospital data. Results: 88 trauma resuscitation patients (mean age 44 years±18 SD, male 74%, mean ISS: 7±5 SD) were enrolled over a 5 month study period. Comparison of immediate and recalled pain scores produced Spearman''s correlation coefficients of 0.71 for initial pain, 0.56 for pain during transport, and 0.45 for minimum pain scores. Discussion: In our study patients did not accurately recall their pain levels 1–2 days after acute trauma. The results suggest that retrospective pain ratings are not reliable in trauma patients. [Copyright &y& Elsevier]

Abstract: Objective: Patient reporting of symptoms in a questionnaire with a 7-day recall period was expected to differ from symptom reporting in a 7-day symptom diary on the basis of cognitive theory of memory processes and several studies of symptoms and health behaviors. Methods: A total of 101 adults with chronic obstructive pulmonary disease (COPD) completed a daily diary of items measuring symptoms and impacts of COPD for 7 days, and on the seventh day they completed a questionnaire of the same items with a 7-day recall period. The analysis examined concordance of 7-day recall with summary descriptors of the daily responses, examined the magnitude and covariates (patient characteristics and response patterns) of the difference between 7-day recall and mean of daily responses, and compared the discriminant ability and ability to detect change of 7-day recall and mean of daily responses. Results: A 7-day recall was moderately concordant with the mean and maximum of daily responses and was 0.34 to 0.50 SDs higher than the mean of daily responses. Only the weekly report itself was a covariate of the difference. The discriminant ability and ability to detect change were equivalent. Conclusions: In measuring the weeklong experience of COPD symptoms and impacts on groups of patients, the 7-day recall scores were higher than the daily diary scores, but equivalent in detecting change over time. [Copyright &y& Elsevier]

Purpose: This study evaluates changes in recall of combat exposures over the first year after return from deployment. The research purpose is to assess whether recall of combat exposures is consistent at different time points; if not, what demographic and/or PTSD symptom risk factors exist for any directional instability. Methods: Surveys completed by soldiers at 3, 6, and 12 months post–Operation Iraqi Freedom (OIF) deployment were linked for longitudinal analysis in a previous study in which three matched datasets were created: 3–6 months (N = 768), 6–12 months (N = 341), and 3–12 months (N = 445). Post-traumatic stress disorder (PTSD) was assessed by using the National Center for PTSD Checklist. The reliability of recall for 36 combat exposures was quantified. The effects of demographics and change in PTSD score on combat exposure recall were assessed. Results: The results showed an average of 80% to 90% agreement in combat exposure reporting between the time points. Every one-unit change in PTSD score was associated with a 0.1- to 0.5-unit change in recall of combat exposures over time. Conclusions: This study demonstrates that over the first year after return from deployment to Iraq, recall of combat experiences remained stable, and PTSD was slightly associated with increased reporting of combat exposures over time. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Ratings of usual pain over a period of 1 week are commonly used to rate a patient''s usual level of pain intensity. This study investigated the validity of weekly recall pain ratings and biasing effects of pain levels on these ratings. Methods: Seventy-eight patients presenting to a chiropractic outpatient clinic with nonspecific neck pain completed a 7-day diary rating their pain 4 times each day on an 11-point numerical rating scale. From these 28 ratings, the patients'' “actual average” pain was computed. On day 8, patients were asked to rate their current pain, as well as recall their pain “on average,” at its “worst,” and at its “least” over the previous week. Results: Recall of average pain over the previous week was shown to be a valid measure using ratings of actual pain as the criterion standard (Pearson r = 0.95). The error between actual and recall readings was random and consistent across all levels of actual pain. Patients were also able to accurately recall their pain at its worst (r = 0.93) and at its least (r = 0.92) over the preceding week. In regression analyses, there were no appreciable biasing effects on the recall of average pain of either current pain at the time of recall, or of pain at its worst or at its least during the recall period. Conclusion: These results suggest that recall ratings of pain intensity may be valid for use in clinical research and practice on patients with nonspecific neck pain. [Copyright &y& Elsevier]

Abstract: This study compared recalled average pain, assessed at the end of the day, with the average of real-time pain ratings recorded throughout the day among patients with osteoarthritis (OA). Participants (N = 157) with hand, hip, or knee OA completed electronic pain diaries on 1 weekend day and 1 weekday. Diaries included at least 7 pain ratings per day, immediately after waking and every 2 hours following, using a visual analog scale (VAS) scored as 1 to 100 (scores not seen by participants). At the end of each diary day, participants rated their average pain that day on the same VAS. Pearson correlations examined associations between recalled average pain and the average of real-time pain ratings that day. Mixed models, including interaction terms, examined whether associations between recalled and actual average pain ratings differed according to the following patient characteristics: joint site, age, race, gender, study enrollment site, and pain catastrophizing. Correlations between recalled and actual average pain ratings were r = .88 for weekdays and r = .86 for weekends (P < .0001). In mixed models, there were no significant interaction terms for any patient characteristics. In summary, patients with OA accurately recalled their average pain over a 1-day period, and this did not differ according to any patient characteristics examined. Perspective: This study showed that patients with OA accurately recalled their average pain over a single-day period, and this did not differ according to patient characteristics. Results of this study indicate that end-of-day recall is a practical and valid method for assessing patients'' average pain during a day. [Copyright &y& Elsevier]

Purpose: Twenty-four–hour diet recall interviews (24HRs) are used to assess diet and to validate other diet assessment instruments. Therefore it is important to know how many 24HRs are required to describe an individual''s intake. Method: Seventy-nine middle-aged white women completed seven 24HRs over a 14-day period, during which energy expenditure (EE) was determined by the doubly labeled water method (DLW). Mean daily intakes were compared to DLW-derived EE using paired t tests. Linear mixed models were used to evaluate the effect of call sequence and day of the week on 24HR-derived energy intake while adjusting for education, relative body weight, social desirability, and an interaction between call sequence and social desirability. Results: Mean EE from DLW was 2115kcal/day. Adjusted 24HR-derived energy intake was lowest at call 1 (1501kcal/day); significantly higher energy intake was observed at calls 2 and 3 (2246 and 2315kcal/day, respectively). Energy intake on Friday was significantly lower than on Sunday. Averaging energy intake from the first two calls better approximated true energy expenditure than did the first call, and averaging the first three calls further improved the estimate (p =0.02 for both comparisons). Additional calls did not improve estimation. Conclusions: Energy intake is underreported on the first 24HR. Three 24HRs appear optimal for estimating energy intake. [Copyright &y& Elsevier]

Objective: This randomized controlled trial aimed to determine whether an interactive CD-ROM improved cancer patients’ recall of chemotherapy treatment information over standard written information, and whether demographic, cognitive, and psychological factors better predicted recall than this format of delivery. Methods: One-hundred-and-one new patients about to commence chemotherapy were randomized to receive written information or a CD-ROM containing treatment information before giving informed consent. Patients’ recall, concentration, short-term memory, reading comprehension, anxiety, depression, and coping styles were assessed with standardized measures pre-treatment. Seventy-seven patients completed tests for recall of treatment information before their second chemotherapy session. Results: Intention-to-treat analyses indicated no significant differences between the written information and CD-ROM groups across recall questions about number of drugs received (p =.43), treatment length (p =.23), and treatment goal (p =.69). Binary logistic regressions indicated that for groups combined different variables predicted each of the recall questions. Conclusion: An interactive CD-ROM did not improve cancer patients’ recall of treatment information enough to warrant changes in consent procedures. Practice implications: Different variables predicted recall of different treatment aspects highlighting the complex nature of attempting to improve patient recall. Attending to the effect of depression on patient knowledge and understanding appears paramount. [Copyright &y& Elsevier]

Abstract: In dietary recall for a specified target period, an intrusion denotes an item reported eaten that was not consumed during that period. Intrusions may denote items available during the specified period, items consumed during other periods, or items from general knowledge of dietary intake. To investigate a cognitive basis of intrusions, we analyzed data from a dietary-reporting validation study in which 69 fourth-grade children were observed eating 2 school meals (breakfast and lunch) and interviewed that evening about that day''s intake in person or by telephone. Of 450 items reported eaten for school meals, 82 were intrusions. Observations and school food service production records were used to determine whether items denoted by intrusions were available in school food service environments on the interview day, as many as 3 school days prior to the interview day, and the day following the interview. Availability of items denoted by intrusions decreased backward over days from the interview day, and decreased from the interview day to the following day. Among 40 children who reported at least 1 intrusion, mean number of intrusions (controlling for number of items reported) increased as interviews occurred later in the week. These results are consistent with the idea that some intrusions are based on specific memories of items encountered but not eaten during the target period, or encountered before the target period. Other intrusions are likely based on general dietary knowledge. It may be possible to design interview techniques to reduce the occurrence of intrusions that are incorrectly based on specific memories. [Copyright &y& Elsevier]

Abstract: While the adverse medical complications and consequences of delirium has been well studied, the same is not true of the psychological morbidity associated with the condition. A better understanding of what it is like to be delirious has the potential to improve recognition, management and treatment of delirium. This article examines the literature relating to the experience of delirium from the perspective of patients, families, and staff. Finally, suggestions for further work that might advance might advance our understanding of these issues are outlined. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate patients'' ability to recall their preoperative self-reported quality of life, function, and general health 2 weeks postoperatively. Study Design and Setting: We randomized consecutive patients undergoing arthroscopic knee surgery to group I (assessments at 4 weeks preoperatively, on the day of surgery, and 2 weeks and 12 months postoperatively) or group II (assessments at 2 weeks and 12 months postoperatively). At each visit patients completed disease-specific, knee-specific, and generic health rating scales. At a median of 2 weeks postoperative (range, 0.6 to 14 weeks), patients completed questionnaires according to their recollection of their health 2 weeks before surgery. Results: Agreement between actual and recalled data was excellent for disease-specific (ICCWOMET =0.88 (95% CI 0.82–0.91), ICCACL-QOL =0.86 (95% CI 0.75–0.91)), knee-specific (ICCIKDC =0.92 (95% CI 0.90–0.94), ICCKOOS =0.93 (95% CI 0.91 to 0.95), and general physical health (ICCSF-36(PCS) =0.81 (95% CI 0.75–0.86)) instruments. Agreement for general mental health was moderate (ICCSF-36(MCS) =0.67 (95% CI 0.58–0.75). Greater error associated with recalled ratings contributed to small increases in sample size requirements or small decreases in power to detect differences between groups. Conclusion: Patients recalled their preoperative quality of life, function, and general health at 2 weeks postoperative with sufficiently high accuracy to warrant substituting prospectively collected baseline data with recalled ratings. [Copyright &y& Elsevier]

The European Food Consumption Survey Method (EFCO- Henauw S, Becker W. A European food consumption survey method- Intake assessment - an ILSI Europe dietary intake and exposure task. [Extracted from the article]

Health departments routinely investigate cases of gastroenteritis through interviews to determine the source of infection. However, validation studies of dietary questionnaires typically focus on quantities consumed and don't assess questions designed to identify sources of foodborne illness. We aimed to assess the accuracy and reliability of information collected by surveys of food history recall for gastroenteritis investigations. A questionnaire was developed to investigate the sources of foodborne gastroenteritis in Australia, with questions on food exposures selected for validation. Fifty-five participants photographed all foods consumed and food receipts obtained during a seven-day observation period. These photographs were uploaded to an online survey or emailed to the researcher. Participants were contacted 14 days later for a telephone interview about foods consumed in the seven-day period. Questionnaire responses were compared to uploaded photographs. Kappa statistics (κ) and 95% confidence intervals were calculated. Sixty-two questions were assessed, including those targeting foods considered high-risk for foodborne gastroenteritis. Potential risk factors covered by these questions included: meats (poultry, beef, pork, and deli meats), the state of poultry purchased (raw versus precooked), and the number of meals eaten outside of the home. Several questions targeting high-risk foods were found to have substantial-to-almost perfect agreement (κ ≥ 0.610) between what was eaten and what was reported by participants, with most questions showing at least a moderate level of agreement (κ = 0.410–0.600). Questions regarding exposure to different types of meat showed a high level of consistency. The only question with poor participant recall (κ < 0.000) was that relating to consumption of undercooked beef or veal. Several questions designed for investigation of gastroenteritis were found to provide at least a moderate level of accurate and reliable recall, even after a delay until interview. These questions are suitable for investigating sources of foodborne gastroenteritis. • Recall of exposure to high-risk foods was assessed. • Most questions showed at least a moderate level of agreement. • Dining locations were assessed as having consistently high recall. • Questions that quantified consumption in number of days had poorer validity. • Questions and results can inform surveys for investigation of gastroenteritis. [ABSTRACT FROM AUTHOR]

Purpose: Data about maternal recall accuracy for classifying early pregnancy medication exposure are meager. Nonetheless, studies often rely on recall to evaluate potential impact of pharmaceuticals on the developing fetus.Methods: Right from the Start is a community-based pregnancy cohort that enrolled women from North Carolina, Tennessee, and Texas. A subset of 318 women participated in daily medication diaries initiated before conception (2006-2012). We examined nonsteroidal anti-inflammatory drugs (NSAIDs) as an example of a drug type that is difficult to study due to its intermittent and primarily over-the-counter use as well as its incomplete documentation in medical and pharmaceutical records. Selective serotonin reuptake inhibitors (SSRI) were assessed as a prescription medication comparator. Maternal recall of NSAID and SSRI use in early pregnancy was examined by comparing diary data (gold standard) to first-trimester interview.Results: Sensitivity and specificity for recall of NSAID exposure were 78.6% and 62.3%, respectively (kappa statistic: 0.41), with 72.3% agreement for exposure classification. Sensitivity and specificity for recall of SSRI exposure were 77.8% and 99.0%, respectively (kappa statistic: 0.79), with 97.8% agreement.Conclusions: Our findings suggest the validity of maternal recall varies with medication type and prospective data collection should be prioritized when studying early pregnancy drug exposures. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of this study is to evaluate if severity of illness in the intensive care unit influences patients'' retrospective recall of their baseline physical function from before hospital admission. Materials and Methods: This is a prospective cohort study of 193 acute lung injury survivors who, before hospital discharge, retrospectively reported their prehospitalization physical function using the Short Form 36 quality of life survey. Results: Four measures were used to evaluate intensive care unit (ICU) severity of illness: (1) Acute Physiology and Chronic Health Evaluation II Acute Physiologic Score at ICU admission, (2) Lung Injury Score at acute lung injury diagnosis, (3) Sequential Organ Failure Assessment score at study enrollment, and (4) maximum daily Sequential Organ Failure Assessment score during the entire ICU stay. In multivariable linear regression analysis, no measure of severity of illness was associated with prehospitalization physical function. Education level significantly modified the relationship between ICU severity of illness and baseline physical function with lower educational attainment having a stronger association with baseline physical function. Conclusion: Intensive care unit severity of illness was not associated with patients'' retrospectively recalled baseline physical function. Patients with a lower level of education may be more influenced by ICU severity of illness, but the magnitude of this effect may not be clinically meaningful. [Copyright &y& Elsevier]