Cognitive processes in pharmacists' clinical decision-making.

BACKGROUND: Pharmacists' clinical decision-making is a core process in pharmaceutical care. However, the practical aspects and effective teaching methods of this process remain largely unexplored. OBJECTIVE: To examine the cognitive processes involved in pharmacists' perceptions of how they make clinical decisions in pharmacy practice. METHODS: Semi-structured, face-to-face interviews were conducted with pharmacists working in community, outpatient, and hospital care in the Netherlands between August and December 2021. Participants were explicitly asked for examples when asked how they make clinical decisions in practice and how they teach this to others. After transcribing audio-recorded interviews, an inductive thematic analysis was conducted to identify cognitive processes. A theoretical model of clinical decision-making was then used and adapted to structure the identified processes. RESULTS: In total, 21 cognitive processes were identified from interviews with 16 pharmacists working in community (n = 5), outpatient (n = 2), and hospital care (n = 9). These cognitive processes were organized into 8 steps of the adapted theoretical model, i.e. problem and demand for care consideration, information collection, clinical reasoning, clinical judgment, shared decision-making, implementation, outcomes evaluation, and reflection. Pharmacists struggled to articulate their clinical decision-making and went back-and-forth in their explanations of this process. All pharmacists emphasized the importance of identifying the problem and described how they collect information through reviewing, gathering, recalling, and investigating. Clinical reasoning entailed various cognitive processes, of which comprehending the problem in the patient's context was deemed challenging at times. Pharmacists seemed least active in evaluating patient outcomes and reflecting on these outcomes. CONCLUSIONS: Pharmacists use multiple cognitive processes when making clinical decisions in pharmacy practice, and their back-and-forth explanations emphasize its dynamic nature. This study adds to a greater understanding of how pharmacists make clinical decisions and to the development of a theoretical model that describes this process, which can be used in pharmacy practice and education.

Routine hoof-trimming data provides insight into the occurrence of claw lesions in Holstein herds in the central region of South Africa.

Claw lesions in dairy cows contribute significantly to lameness, causing distress and discomfort for affected cows and raising welfare concerns. Despite increased awareness, lameness incidence continues to rise. Defining and recording claw traits are particularly problematic. In South Africa (SA), claw data is limited to paper-based records kept by private hoof trimmers. This research analysed claw-trimming data from five dairy farms over 6 years to examine the occurrence and recording of claw lesions in SA Holstein cattle. Lesion identification followed the Claw Lesion Identification in Dairy Cattle brochure. Among the recorded lesions, digital dermatitis (DD) had the highest prevalence (64.02%), followed by sole ulcers (SU; 8.59%), white line disease (WLD; 6.27%), and sole haemorrhage (SH; 4.28%), and most lesions occurred in the rear feet. Chi-square tests and correspondence analysis (CA) were employed to explore the relationships between lesions, feet, and housing. Results indicated that the prevalence of SU and SH showed high similarity for foot and lesion association, and that these were more highly associated with the rear feet. Additionally, the prevalence of DD and interdigital phlegmon were strongly associated, and closely associated with SU, and all these lesions were associated with both dirt lot and free-stall housing systems. CA further confirmed a close association between WLD and SH, and the prevalence of these lesions in the combination housing system. Results of this study highlight the complexity of lesion data and that specific associations between lesions could lead to simplifying the recording thereof. Consolidating the most informative claw lesions into categories will aid in the practical prevention, management, and treatment of lameness on-farm.

Factors influencing pharmacists' clinical decision making in pharmacy practice.

BACKGROUND: Pharmacists' clinical decision-making is considered a core process of pharmaceutical care in pharmacy practice, but little is known about the factors influencing this process. OBJECTIVE: To identify factors influencing clinical decision-making among pharmacists working in pharmacy practice. METHODS: Semi-structured interviews were conducted with pharmacists working in primary, secondary, and tertiary care settings in the Netherlands between August and December 2021. A thematic analysis was conducted using an inductive approach. The emerged themes were categorized into the Capability-Opportunity-Motivation-Behaviour (COM-B) model domains. RESULTS: In total, 16 pharmacists working in primary care (n = 7), secondary care (n = 4) or tertiary care (n = 5) were interviewed. Factors influencing pharmacists' capability to make clinical decisions are a broad theoretical knowledge base, clinical experience, and skills, including contextualizing data, clinical reasoning, and clinical judgment. The pharmacy setting, data availability, rules and regulations, intra- and interprofessional collaboration, education, patient perspectives, and time are mentioned as factors influencing their opportunity. Factors influencing pharmacists' motivation are confidence, curiosity, critical thinking, and responsibility. CONCLUSIONS: The reported factors covered all domains of the COM-B model, implying that clinical decision-making is influenced by a combination of pharmacists' capability, opportunity, and motivation. Addressing these different factors in pharmacy practice and education may improve pharmacists' clinical decision-making, thereby improving patient outcomes.

Communication and relationship building in pharmacy education: Experiences from a student-patient buddy project.

BACKGROUND AND PURPOSE: In order to deliver patient-centred pharmaceutical care, pharmacy students need to develop the appropriate competences and skills. During their regular study program, they have limited long-term patient contact. We therefore implemented a student-patient buddy project to give students opportunity to practice and learn from the patient contact. EDUCATIONAL ACTIVITY AND SETTING: A student-patient buddy project was implemented in a 10-week first-year master experiential learning course, including a community pharmacy internship. The pharmacist paired the student with a community-dwelling patient. Student learning activities included: (1) three meetings at the university to prepare and discuss buddy contact moments, (2) three buddy contact moments, (3) discussion with the internship providing pharmacist, and (4) a written reflection report. FINDINGS: In total, 66 students participated from April to June 2021. Most students found patient contact fun and a useful learning experience. Students mentioned that patients were very open and there was opportunity to build a relationship. The first conversation was experienced as exciting and sometimes difficult. Understanding the person was perceived as important. Internship pharmacists were positive about the project and saw learning benefits for students, as well as added value for the pharmacy, mainly because patients seemed to appreciate the contact. SUMMARY: A student-patient buddy project is a good way to expand the limited long-term "real" patient care experiences of pharmacy students. This enables them to practice communication and building relationships with patients.

Feasibility, safety, and efficacy of early prophylactic donor lymphocyte infusion after T cell-depleted allogeneic stem cell transplantation in acute leukemia patients.

Prophylactic donor lymphocyte infusion (DLI) starting at 6 months after T cell-depleted allogeneic stem cell transplantation (TCD-alloSCT) can introduce a graft-versus-leukemia (GvL) effects with low risk of severe graft-versus-host-disease (GvHD). We established a policy to apply low-dose early DLI at 3 months after alloSCT to prevent early relapse. This study analyzes this strategy retrospectively. Of 220 consecutive acute leukemia patients undergoing TCD-alloSCT, 83 were prospectively classified to have a high relapse risk and 43 were scheduled for early DLI. 95% of these patients received freshly harvested DLI within 2 weeks of the planned date. In patients transplanted with reduced intensity conditioning and an unrelated donor, we found an increased cumulative incidence of GvHD between 3 and 6 months after TCD-alloSCT for patients receiving DLI at 3 months compared to patients who did not receive this DLI (0.42 (95%Confidence Interval (95% CI): 0.14-0.70) vs 0). Treatment success was defined as being alive without relapse or need for systemic immunosuppressive GvHD treatment. The five-year treatment success in patients with acute lymphatic leukemia was comparable between high- and non-high-risk disease (0.55 (95% CI: 0.42-0.74) and 0.59 (95% CI: 0.42-0.84)). It remained lower in high-risk acute myeloid leukemia (AML) (0.29 (95% CI: 0.18-0.46)) than in non-high-risk AML (0.47 (95% CI: 0.42-0.84)) due to an increased relapse rate despite early DLI.

Tracking the progeny of adoptively transferred virus-specific T cells in patients posttransplant using TCR sequencing.

Adoptive cellular therapies with T cells are increasingly used to treat a variety of conditions. For instance, in a recent phase 1/2 trial, we prophylactically administered multivirus-specific T-cell products to protect recipients of T-cell-depleted allogeneic stem cell grafts against viral reactivation. To establish treatment efficacy, it is important to determine the fate of the individual transferred T-cell populations. However, it is difficult to unequivocally distinguish progeny of the transferred T-cell products from recipient- or stem cell graft-derived T cells that survived T-cell depletion during conditioning or stem cell graft manipulation. Using messenger RNA sequencing of the T-cell receptor ß-chains of the individual virus-specific T-cell populations within these T-cell products, we were able to track the multiple clonal virus-specific subpopulations in peripheral blood and distinguish recipient- and stem cell graft-derived virus-specific T cells from the progeny of the infused T-cell products. We observed in vivo expansion of virus-specific T cells that were exclusively derived from the T-cell products with similar kinetics as the expansion of virus-specific T cells that could also be detected before the T-cell product infusion. In addition, we demonstrated persistence of virus-specific T cells derived from the T-cell products in most patients who did not show viral reactivation. This study demonstrates that virus-specific T cells from prophylactically infused multiantigen-specific T-cell products can expand in response to antigen encounter in vivo and even persist in the absence of early viral reactivation.

Exploring the effect of auditory stimuli on activity levels, milk yield and faecal glucocorticoid metabolite concentrations in Holstein cows.

Health and welfare are inextricably linked within efficient and sustainable dairy production, and several potential risk factors may affect the well-being of dairy cows, including chronic stress. Although auditory stimuli could be used as a tool to decrease the potential stress that cows might experience, it is seldom applied to livestock production systems due to the perception that enrichment is an unnecessary expense. This study aimed to explore the effect of auditory stimuli as a form of enrichment in a Holstein herd by monitoring fecal glucocorticoid metabolite (fGCM) concentrations (a non-invasive, stress-associated biomarker). Cow activity level and milk yield were also measured. Nine cows in their second and third lactation were divided into 3 groups, using a Latin Square experimental design, exposing each cow group to each of the 3 treatments, namely constant exposure (CE), limited exposure (LE), and no exposure (NE) to classical music. FGCMs were quantified using a group-specific enzyme immunoassay detecting 11,17-dioxoandrostanes. Compared to LE and NE animals, cows exposed to constant music had significantly lower fGCM concentrations (P = 0.012), as well as higher milk yields (P < 0.0001) and lowered activity levels during the morning (P = 0.005) and the evening activity period (P = 0.048). These findings indicate that auditory stimuli in the form of classical music may have a positive effect on the welfare of cows as well as milk yield, which hold economic benefits for the producer and potentially reduces the number of cows needed for profitable production.

A within- and across-country assessment of the genomic diversity and autozygosity of South African and eSwatini Nguni cattle.

In southern Africa, the Nguni cattle breed is classified as an indigenous and transboundary animal genetic resource (AnGR) that manifests unique adaptation abilities across distinct agroecological zones. The genetic integrity of various ecotypes is under potential threat due to both indiscriminate crossbreeding and uncontrolled inbreeding. The aim of this study was to assess the genetic diversity and autozygosity that exist both across countries (ES: eSwatini; SA: South Africa) and within countries (SA), between purebred stud animals (SA-S) and research herds (SA-R). Subsets of 96 ES, 96 SA-S, and 96 SA-R genotyped for 40,930 common SNPs were used to study genome-wide profiles of runs of homozygosity (ROH) and heterozygosity (ROHet) as well as inbreeding levels and population structure. The highest percentage (39.8%) of the 2168 ROH segments was 4-8 Mbp in length, whereas 65% of the 935 ROHet segments fell within the 0.5-1 Mbp length category. Inbreeding coefficients indicated positive but low inbreeding (FROH>1Mbp range: 0.025 for SA-S to 0.029 for SA-R). Principal component (PCA) and population structure analyses illustrated genome-level distinctness of (1) the Nguni from global indicine (Boran) and taurine (Hereford) breeds (K = 3), (2) the SA Nguni populations from the ES Nguni population (K = 4), and (3) different Nguni ecotypes within countries (K = 8). Furthermore, greater admixture was observed for the SA-R population compared to purebred SA-S population (shared ancestry = 0.631 ± 0.353 compared to 0.741 ± 0.123), and fewer genomics-defined ES ecotypes were observed than phenotypically (pre)defined. Overall, the results illustrated that genetic uniqueness within the sampled Nguni cattle resulted from both geographic isolation and exposure to different breeding strategies (and, selection pressures). A further loss of genetic variability should be monitored to prevent the endangerment of unique and beneficial ecotypes.

Is Novelty Detection Important in Long-Term Odor Memory?

Memory for odors is believed to be longer-lasting than memory for visual stimuli, as is evidenced by flat forgetting curves. However, performance on memory tasks is typically weaker in olfaction than vision. Studies of odor memory that use forced-choice methods confound responses that are a result of a trace memory and responses that can be obtained through process of elimination. Moreover, odor memory is typically measured with common stimuli, which are more familiar and responses may be confounded by verbal memory, and measure memory in intentional learning conditions, which are ecologically questionable. Here we demonstrate the value of using tests of memory in which hit rate and correct rejection rate are evaluated separately (i.e., not using forced-choice methods) and uncommon stimuli are used. This study compared memory for common and uncommon odors and pictures that were learned either intentionally (Exp. 1) or incidentally (Exp. 2) and tested with either a forced-choice or a one-stimulus-at-a-time ("monadic") recognition task after delays of 15 min, 48 h or 1 week. As expected, memory declined with delay in most conditions, but depended upon the particular measure of memory and was better for pictures than odors and for common than uncommon stimuli. For common odors, hit rates decreased with delay but correct rejection rates remained constant with delay. For common pictures, we found the opposite result, constant hit rates and decreased correct rejection rates. Our results support the 'misfit theory of conscious olfactory perception', which highlights the importance of the detection of novelty in olfactory memory and suggests that olfactory memory should be studied using more ecologically valid methods.

Moving towards sustainable breeding objectives and cow welfare in dairy production: a South African perspective.

Genetic advancements have resulted in improved dairy production over many decades, due to the focus of breeding objectives on production as the driving force for genetic progress and overall farm profitability. Major advancements were made in the easy-to-measure traits with moderate to high heritability, which resulted in unintended consequences on herd fertility, health, and welfare of cows. In addition, climate change and animal welfare concerns demanded balanced breeding objectives and selection approaches for sustainable production-including health and longevity. The inclusion of genomic information into genetic evaluations has been proved to benefit traits associated with welfare and sustainable production. Cow welfare traits remain complex and suitable phenotypes are not always easy to measure or readily available for genetic evaluations. The challenge for improvement of cow welfare often lies within implementation of sensitive and measurable parameters. The aim of this review was to explore the reconsideration of breeding objectives in the dairy industry towards sustainable dairy production and cow welfare with reference to selection of dairy animals in South Africa.

[The impact of comorbid personality disorders on the effectiveness of acute phase treatments for depression: a meta-analysis and meta-regression]. / De impact van comorbide persoonlijk­heidsstoornissen op de effectiviteit van acute-fasebehandeling van depressie: een meta-analyse en metaregressie.

BACKGROUND: Results from previous meta-analyses of the impact of comorbid personality disorders (PD's) on treatment outcomes for depressive disorder are contradictory and biased by methodological differences between included studies. AIM: To investigate the impact of comorbid PD on the outcome of depression treatments, using only studies with controlled treatments and structured measurement instruments (PROSPERO, CRD42019120200). METHOD: Studies were searched in PubMed, PsycINFO and Embase, and in reference lists of selected articles and previous meta-analyses. Treatment studies for depression with a subset of individuals with comorbid PD were included. Primary outcome was depression severity change during treatment. Effect sizes were estimated using random effect models, study-level variables were examined with meta-regression. Bias was assessed with the Risk of Bias tool. RESULTS: Six studies involving 942 individuals (447 with PD) were included. There was no significant difference in depression severity reduction between individuals with and without PD (g = 0.03, 95% CI -0.15-0.20, p = 0.27). Heterogeneity and risk of bias were low. The meta-regression did not yield significant results. CONCLUSION: Findings don't indicate an impact of comorbid PD on the outcome of acute phase treatment for depression. Depressed patients with and without comorbid PD should receive the same evidence-based depression treatments.

Population structure of indigenous southern African goats based on the Illumina Goat50K SNP panel.

In this study, the genetic structure of indigenous Tswana and Swazi goats using the Illumina Goat50K SNP array was investigated. Two South African commercial goat breeds were included to investigate admixture with the indigenous populations in southern Africa. A total of 144 DNA samples including Boer goats (n = 24), Kalahari Red (n = 24), Swazi (n = 48), and Tswana goats (n = 48) were genotyped. Statistical analysis was performed using PLINK version 1.07. Genetic diversity, measured as expected heterozygosity, was estimated at 0.390, 0.398, 0.413, and 0.387 for Boer, Kalahari Red, Tswana, and Swazi goats, respectively. The individual inbreeding coefficient varied from 0.019 ± 0.05 to 0.011 ± 0.06 for the Tswana and Swazi goats, respectively. The Principal component analysis clustered the populations according to geographical origin and breed type. Linkage disequilibrium (LD) for shorter intervals (0-10 kb) ranged from 0.44 to 0.56 and commercial breeds had higher values. Effective population sizes decreased with generations and at the 13th generation ranged between 87 for Boer to 266 for Tswana goats. The Tswana population exhibited the highest level of genetic variation and effective population size, which holds potential for improved production in marginal regions. A national strategy is required to maintain genetic diversity in communal goat production systems through well-structured breeding and conservation programs.

Gene expression profiles of the small intestine of village chickens from an Ascaridia galli infested environment.

Nematodes of the genus Ascaridia are known to infect many species of birds and result in fatal diseases. A. galli damages the intestinal mucosa of chickens leading to blood loss, secondary infection and occasionally the obstruction of small intestines due to high worm burden. This study investigated the gene expression profiles in chickens from two different provinces of South Africa naturally exposed to A. galli infestations and tested either positive or negative for the parasite. The study further investigated gene expression profiles of the A. galli infected duodenum, jejunum and ileum tissues of the small intestines. The A. galli positive intestines displayed hypertrophy of the intestinal villi with accumulation of inflammatory cells and necrosis of the crypts of Lieberkühn glands, lesions that were absent in the uninfected intestines. Total RNA isolated from small intestines of infected and non-infected intestines was sequenced using Illumina HiSeq technology to generate up to 23,856,130 reads. Between any two-way comparisons of the intestines, 277 and 190 transcripts were significantly expressed in Limpopo and KwaZulu-Natal (KZN) chickens, respectively. Gene ontology analysis of the differentially expressed genes (DEGs) revealed an enrichment of genes reported to function in the immune response, defense response, inflammatory response and cell signalling genes. T cell receptor signalling pathways and arachidonic acid metabolism pathways were among the most significantly impacted pathways. Overall, the study provided insights into adaptative mechanisms for chickens extensively raised in parasite infected environments.

Gene expression profiles of the small intestine of village chickens from an Ascaridia galli infested environment.

Nematodes of the genus Ascaridia are known to infect many species of birds and result in fatal diseases. A. galli damages the intestinal mucosa of chickens leading to blood loss, secondary infection and occasionally the obstruction of small intestines due to high worm burden. This study investigated the gene expression profiles in chickens from two different provinces of South Africa naturally exposed to A. galli infestations and tested either positive or negative for the parasite. The study further investigated gene expression profiles of the A. galli infected duodenum, jejunum and ileum tissues of the small intestines. The A. galli positive intestines displayed hypertrophy of the intestinal villi with accumulation of inflammatory cells and necrosis of the crypts of Lieberkühn glands, lesions that were absent in the uninfected intestines. Total RNA isolated from small intestines of infected and non-infected intestines was sequenced using Illumina HiSeq technology to generate up to 23,856,130 reads. Between any two-way comparisons of the intestines, 277 and 190 transcripts were significantly expressed in Limpopo and KwaZulu-Natal (KZN) chickens, respectively. Gene ontology analysis of the differentially expressed genes (DEGs) revealed an enrichment of genes reported to function in the immune response, defense response, inflammatory response and cell signalling genes. T cell receptor signalling pathways and arachidonic acid metabolism pathways were among the most significantly impacted pathways. Overall, the study provided insights into adaptative mechanisms for chickens extensively raised in parasite infected environments.

[Ten years of cognitive control training for depression: an overview of findings and challenges]. / Tien jaar cognitieve controletraining voor depressie: een overzicht van verwezenlijkingen en uitdagingen.

BACKGROUND: 2007 marks a shift in scientific literature on the cognitive vulnerabilities of depression. Preceded by a vast amount of studies exploring neuroplasticity and cognitive transfer effects, Siegle e.a. (Cognit Ther Res 2007; 31: 235-62) published the findings of a proof-of-principle study in which cognitive control training (cct) was applied to treat depression. This denotes an evolution towards clinically oriented cct studies targeting reduction of the vulnerability mechanisms of depression. Following this publication, several studies tested the effects of cct on emotional vulnerability. These studies show great variability.
AIM: This article provides an overview summarizing the findings of cct for depression published in the last 10 years.
METHOD: The results of a recently conducted systematic review were reviewed, with a particular interest in clinical implications and challenges.
RESULTS: cct shows beneficial effects on indicators of depression vulnerability (e.g., stress reactivity, rumination, symptomatology). Associated literature underlines the importance of intensive training procedures, use of an affective task context and task motivation.
CONCLUSION: cct shows potential as a clinical intervention for depression. However, several questions still need to be addressed before implementation into clinical practice is warranted.

Gastrostomy placement : when fluoroscopy helps the endoscopist.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy is the most common therapeutic procedure performed by the digestive endoscopists in the upper gastrointestinal tract. It aims to feed patients presenting denutrition and/or insufficient oral intake. Percutaneous endoscopic gastrostomy feasibility is about 95-100 % although in some cases it is impossible to achieve it, leading to ask for a surgical placement. Even though the feasibility of the surgical approach is excellent its complications are quite higher than percutaneous endoscopic placement, it requires general anesthesia and sometimes these patients could be non elligible for it due to their comorbidities (malnutrition, cardio-vascular diseases etc.). Another alternative technique is the percutaneous radiological gastrostomy but this procedure is rarely available in our country. PATIENTS AND METHODS: We described four cases in patients with previous failure of PEG, in which we used an hybrid approach between radiological and endoscopic techniques, allowing the placement of gastrostomy tube, without general anesthesia. RESULTS: This was successful in all patients and there was no complication related to the procedure. CONCLUSIONS: This technique offers an additionnal opportunity to avoid general anesthesia and surgical complications in patients with unfavorable conditions.

A survey analysis of indigenous goat production in communal farming systems of Botswana.

A total of 153 communal farmers in four agro-ecological regions of Botswana were interviewed using a structured questionnaire. The aims of the survey were to characterise existing communal goat production systems, evaluate the importance of goats to farmers and identify breeding practices and constraints encountered in goat production in Botswana. Data was collected on socio-economic parameters, general and breeding management practices and major constraints limiting goat production in Botswana. All respondents were small-scale communal farmers with 63% respondents practising mixed crop-livestock farming and 37% keeping livestock as their primary activity. The majority (33%) of respondents were older than 60 years. Over 80% of the farmers kept goats for cash required for tuition, school uniforms and household commodities as well as re-stocking of animals. Most farmers (62%) kept indigenous crossed genotypes. Generally, uncontrolled mating was practised with the majority of farmers (41%) using on-farm reared bucks for more than two years of breeding and communal bucks (36%) as an alternative. The major constraints limiting goat productivity in communal areas included uncontrolled breeding, predators, theft and diseases. Issues raised by farmers should be considered in designing and implementing effective breeding programs for goats to improve their overall productivity and contribution to poverty alleviation in these communities.

Health status in Europe: comparison of 24 urban areas to the corresponding 10 countries (EURO-URHIS 2).

Background: : In Europe, over 70% of the population live in urban areas (UAs). Most international comparative health research is done using national level data, as reliable and comparable urban data are often unavailable or difficult to access. This study aims to investigate whether population health is different in UAs compared with their corresponding countries. : Routinely available health-related data were collected by the EURO-URHIS 2 project, for 10 European countries and for 24 UAs within those countries. National and UA level data for 11 health indicators were compared through the calculation of relative difference, and geographical patterns within Europe were investigated using the Mann Whitney U test. Linear regression modelling was used to adjust for population density, gross domestic product and urbanicity. : In general, the urban population in Eastern Europe is less healthy than the Western European urban population. However, people in Eastern Europe have significantly better broad health outcomes in UAs as compared with the corresponding country as a whole, whereas people in Western Europe have generally worse broader health outcomes in UAs. : For most European countries and UAs that were investigated, the national level health status data does not correspond with the health status at UA level. In order to identify health problems in UAs and to provide information for local health policy, health monitoring and international benchmarking should also be conducted at the local level.

Health literacy of patients admitted for elective surgery.

AIM: Patients with limited health literacy have poorer surgical outcomes. However, current studies assessing the prevalence of limited health literacy in patients expecting surgery are small scale. We aimed to provide insight into the health literacy level of patients undergoing planned surgery. SUBJECT AND METHODS: Patients aged ≥18 years visiting the preoperative screening department were approached in the waiting area and invited to participate in a brief interview including the Functional Communicative Critical Health Literacy (FCCHL). RESULTS: In total, 225 patients (84.9% response) were studied. Based on the FCCHL, 37.3% of the patients were classified as having limited health literacy. The mean score in the critical domain (2.7 ± 0.9) was lower than scores in the functional (3.3 ± 0.6) and communicative (3.3 ± 0.6) domains. CONCLUSION: More than one third of the patients admitted to the hospital for surgery had limited health literacy. Healthcare professionals should be aware of the different health literacy levels and tailor their information provision strategies accordingly.