Functional anatomic dissociation of description and picture naming in the left temporal lobe.

Functional magnetic resonance imaging (fMRI) was used in a non-patient experimental sample to assess the neuroanatomical dissociation of picture and description naming (PN and DN) in temporal lobe (TL). The purpose was to determine the generalizability of findings in semantic organization in the epilepsy patient population to the broader population. It was hypothesized that, akin to patient derived findings, DN would uniquely activate left TL regions anterior to those associated with PN, while overlapping in middle and posterior left TL. Participants (n = 16) underwent fMRI while silently naming target words during a picture naming task (PNT; line drawings) and description naming task (DNT; orthographic phrases). Analysis was a priori restricted to the left TL. Group results of direct contrasts (DNT > PNT and PNT > DNT) confirmed the hypothesized dissociation with DNT > PNT activating anterior left TL. Within-condition contrasts (DNT and PNT alone) yielded additional support, revealing areas of shared and unique activation in each condition. This is the first imaging study to contrast DN and PN in the same sample. The results suggest DN and PN are meaningfully different constructs subserved by converging and diverging TL neuroanatomy and may be differentially affected by disease.

Deficits in retention for verbally presented medical information.

BACKGROUND: Anesthesiologists deliver large quantities of verbal information to patients during preoperative teaching. Basic principles of cognitive psychology dictate that much of this information is likely to be forgotten. Exactly how much and what type of information can be retained and recalled remains an open question. METHODS: With Institutional Review Board approval, 98 healthy, educated volunteers viewed a brief video containing a preoperative explanation of anesthetic options and instructions. Subjects were then asked to engage in free and cued recall of information from the video, and to complete a recognition task. We developed a coding scheme to objectively score the free and cued recall tasks for the quantity of information recalled relative to the quantity presented in the video. Data are presented as descriptive statistics. RESULTS: Subjects spontaneously recalled less than 25% of the information presented. Providing retrieval cues greatly enhanced recall: Subjects recalled 67%, on average, of the material queried in the cued recall task. Performance was even stronger on the multiple-choice test (83% of items correctly answered), indicating that the information was initially encoded. The category of information that was consistently least-remembered was presurgical medication instructions. CONCLUSIONS: Under realistic conditions for recall, most medical instruction given to patients will not be recalled, even if it is initially encoded. Given the limits of short-term memory, clinicians should carefully consider their patterns of information giving. Improvement of memory performance with cues for retrieval indicates that providing printed instructions for later review may be beneficial.

A controlled study of the effects of patient information-elicitation style on clinician information-giving.

Although effective communication improves the quality of the relationships between patients and medical clinicians, resulting in better outcomes for patients, little is known about how patients influence that communication. Using a controlled, repeated measures design we investigated the role that patient question-asking plays in shaping the communication behaviors of health care providers. Medical students participated in simulated medical consultations with confederate patients adopting different information-elicitation styles. We examined the effects of passive, neutral, and highly-assertive questioning on the quantity of information delivered. Passive patients, who asked no questions and avoided eye contact, received less information (95.4 +/- 27.4 discrete items) than neutral patients (122.6 +/- 33.0 items). Highly-assertive patients, who engaged in active question-asking, sustained eye contact and used positive body language received the most information (135.6 +/- 46.9 items). The greater quantity of information given to highly-assertive patients was not accounted for solely by answers to questions. The increased information delivery elicited by highly-assertive patients is especially important when considered in light of memory limitations.

Clinicians consistently exceed a typical person's short-term memory during preoperative teaching.

INTRODUCTION: Patient education is a critical part of preparation for surgery. Little research on provider-to-patient teaching has been conducted with systematic focus on the quantity of information provided to patients. This is important to assess because short-term memory capacity for information such as preoperative instruction is limited to roughly seven units of content. METHODS: We studied the information-giving practices of anesthesiologists and nurse practitioners during preoperative teaching by examining transcripts from 26 tape recorded preoperative evaluation appointments. We developed a novel coding system to measure: 1) quantity of information, 2) frequency of medical terminology, 3) number of patient questions, and 4) number of memory reinforcements used during the consultation. Results are reported as mean +/- sd. RESULTS: Anesthesiologists and nurse practitioners vastly exceeded patients' short-term memory capacity. Nurse practitioners gave significantly more information to patients than did physicians (112 +/- 37 vs 49 +/- 25 items per interview, P < 0.01). This higher level of information-giving was not influenced by the question-asking behaviors of the patients. Nurse practitioners and physicians used similar numbers of medical terms (4.0 +/- 2.4 vs 3.7 +/- 2.8 explained terms per interview), and memory-supporting reinforcements (2.3 +/- 3.0 vs 1.4 +/- 2.0 reinforcements per interview). DISCUSSION: Given the known limits of short-term memory, clinicians would be well advised to carefully consider their patterns of information-giving and their use of memory-reinforcing strategies for critical information.

Real-time checking of electronic anesthesia records for documentation errors and automatically text messaging clinicians improves quality of documentation.

INTRODUCTION: The quality of electronic anesthesia documentation is important for downstream communication and to demonstrate appropriate diligence to care. Documentation quality will also impact the success of reimbursement contracts that require timely and complete documentation of specific interventions. We implemented a system to improve completeness of clinical documentation and evaluated the results over time. METHODS: We used custom software to continuously scan for missing clinical documentation during anesthesia. We used patient allergies as a test case, taking advantage of a unique requirement in our system that allergies be manually entered into the electronic record. If no allergy information was entered within 15 min of the "start of anesthesia care" event, a one-time prompt was sent via pager to the person performing the anesthetic. We tabulated the daily fraction of cases missing allergy data for the 6 mo before activating the alert system. We then obtained the same data for the subsequent 9 mo. We tested for systematic performance changes using statistical process control methodologies. RESULTS: Before initiating the alert system, the fraction of charts without an allergy comment was slightly more than 30%. This decreased to about 8% after initiating the alerts, and was significantly different from baseline within 5 days. Improvement lasted for the duration of the trial. Paging was suspended on nights, weekends, and holidays, yet weekend documentation performance also improved, indicating that weekday reminders had far-reaching effects. DISCUSSION: Electronic anesthesia documentation performance can be rapidly managed and improved by using an automatic process monitoring and alerting system.