Neutral auditory words immediately followed by painful electric shock may show reduced next-day recollection.

In this study, we investigated the effect of experimentally delivered acute pain on memory. Twenty-five participants participated in experimental sessions on consecutive days. The first session involved a categorization task to encourage memory encoding. There were two conditions, presented in randomized order, in which participants listened to a series of words, which were repeated three times. In one condition, one-third of the word items were immediately followed by a painful electrical shock. This word-shock pairing was consistent across repetition and the pain-paired items were presented unpredictably. In the other condition, all word items were not associated with pain. Response times over these repeated presentations were assessed for differences. Explicit memory was tested the following day, employing a Remember-Know assessment of word recognition, with no shocks employed. We found evidence that recollection may be reduced for pain-paired words, as the proportion of correct Remember responses (out of total correct responses) was significantly lower. There were no significant reductions in memory for non-pain items that followed painful stimulation after a period of several seconds. Consistent with the experience of pain consuming working memory resources, we theorize that painful shocks interrupt memory encoding for the immediately preceding experimental items, due to a shift in attention away from the word item.

Midazolam and Ketamine Produce Distinct Neural Changes in Memory, Pain, and Fear Networks during Pain.

BACKGROUND: Despite the well-known clinical effects of midazolam and ketamine, including sedation and memory impairment, the neural mechanisms of these distinct drugs in humans are incompletely understood. The authors hypothesized that both drugs would decrease recollection memory, task-related brain activity, and long-range connectivity between components of the brain systems for memory encoding, pain processing, and fear learning. METHODS: In this randomized within-subject crossover study of 26 healthy adults, the authors used behavioral measures and functional magnetic resonance imaging to study these two anesthetics, at sedative doses, in an experimental memory paradigm using periodic pain. The primary outcome, recollection memory performance, was quantified with d' (a difference of z scores between successful recognition versus false identifications). Secondary outcomes were familiarity memory performance, serial task response times, task-related brain responses, and underlying brain connectivity from 17 preselected anatomical seed regions. All measures were determined under saline and steady-state concentrations of the drugs. RESULTS: Recollection memory was reduced under midazolam (median [95% CI], d' = 0.73 [0.43 to 1.02]) compared with saline (d' = 1.78 [1.61 to 1.96]) and ketamine (d' = 1.55 [1.12 to 1.97]; P < 0.0001). Task-related brain activity was detected under saline in areas involved in memory, pain, and fear, particularly the hippocampus, insula, and amygdala. Compared with saline, midazolam increased functional connectivity to 20 brain areas and decreased to 8, from seed regions in the precuneus, posterior cingulate, and left insula. Compared with saline, ketamine decreased connectivity to 17 brain areas and increased to 2, from 8 seed regions including the hippocampus, parahippocampus, amygdala, and anterior and primary somatosensory cortex. CONCLUSIONS: Painful stimulation during light sedation with midazolam, but not ketamine, can be accompanied by increased coherence in brain connectivity, even though details are less likely to be recollected as explicit memories.

Memory for non-painful auditory items is influenced by whether they are experienced in a context involving painful electrical stimulation.

In this study, we sought to examine the effect of experimentally induced somatic pain on memory. Subjects heard a series of words and made categorization decisions in two different conditions. One condition included painful shocks administered just after presentation of some of the words; the other condition involved no shocks. For the condition that included painful stimulations, every other word was followed by a shock, and subjects were informed to expect this pattern. Word lists were repeated three times within each condition in randomized order, with different category judgments but consistent pain-word pairings. After a brief delay, recognition memory was assessed. Non-pain words from the pain condition were less strongly encoded than non-pain words from the completely pain-free condition. Recognition of pain-paired words was not significantly different than either subgroup of non-pain words. An important accompanying finding is that response times to repeated experimental items were slower for non-pain words from the pain condition, compared to non-pain words from the completely pain-free condition. This demonstrates that the effect of pain on memory may generalize to non-pain items experienced in the same experimental context.

Reporting of Patient Experience Data on Health Systems' Websites and Commercial Physician-Rating Websites: Mixed-Methods Analysis.

BACKGROUND: Some hospitals' and health systems' websites report physician-level ratings and comments drawn from the Consumer Assessment of Healthcare Providers and Systems surveys. OBJECTIVE: The aim was to examine the prevalence and content of health system websites reporting these data and compare narratives from these sites to narratives from commercial physician-rating sites. METHODS: We identified health system websites active between June 1 and 30, 2016, that posted clinician reviews. For 140 randomly selected clinicians, we extracted the number of star ratings and narrative comments. We conducted a qualitative analysis of a random sample of these physicians' narrative reviews and compared these to a random sample of reviews from commercial physician-rating websites. We described composite quantitative scores for sampled physicians and compared the frequency of themes between reviews drawn from health systems' and commercial physician-rating websites. RESULTS: We identified 42 health systems that published composite star ratings (42/42, 100%) or narratives (33/42, 79%). Most (27/42, 64%) stated that they excluded narratives deemed offensive. Of 140 clinicians, the majority had composite scores listed (star ratings: 122/140, 87.1%; narrative reviews: 114/140, 81.4%), with medians of 110 star ratings (IQR 42-175) and 25.5 (IQR 13-48) narratives. The rating median was 4.8 (IQR 4.7-4.9) out of five stars, and no clinician had a score less than 4.2. Compared to commercial physician-rating websites, we found significantly fewer negative comments on health system websites (35.5%, 76/214 vs 12.8%, 72/561, respectively; P<.001). CONCLUSIONS: The lack of variation in star ratings on health system sites may make it difficult to differentiate between clinicians. Most health systems report that they remove offensive comments, and we notably found fewer negative comments on health system websites compared to commercial physician-rating sites.

Psychometric and electrodermal activity data from an experimental paradigm of memory encoding with some items periodically followed by painful electric shock.

How pain influences explicit memory is an active area of investigation, and next-day recognition was the primary outcome of this experiment. The data reported here were secondary measures of psychometrics to quantify interindividual variability between subjects and measure electrodermal activity (EDA) changes in response to experimental stimuli. Reliable EDA responses following painful electric shocks were obtained in the Learning portion of the experiment. During next-day testing, however, no reliable EDA responses were elicited, including to previously pain-paired experimental items.

Financial Incentive, in Place of Nonclinical Time, Increases Faculty Involvement and Improves Resident Didactic Evaluation Scores in an Anesthesiology Residency Training Program.

BACKGROUND: Providing clinical faculty to lead high-quality resident didactic sessions remains a challenge for academic departments that host graduate medical education training programs. In an effort to both reduce costs and to continue to recruit faculty to give lectures, our department began to incentivize clinicians with a $500 stipend in place of a nonclinical day to present didactics. Our hypothesis is that with financial incentive, more attendings would present didactics and the quality would improve. METHODS: Residents routinely evaluate all didactic sessions using a Likert scale of 1 to 5. Residents also answer yes or no to indicate whether the presenter should return. We compared academic year (AY) 2016, in which faculty were incentivized with nonclinical time, with AY 2017 and AY 2018, in which incentive came in the form of a $500 stipend. For each, the mean Likert score and percentage of positive responses for lecturer returning were calculated. A 1-way ANOVA and post hoc t tests were performed to determine significant changes. RESULTS: Comparing AY 2016 (before the incentive switch) with AY 2017 and AY 2018, there was more faculty involvement in resident didactic after implementing the financial incentive. The quality of lectures also improved after the incentive switch, according to resident evaluations. There were higher overall Likert scores in AY 2018 and a higher percentage of positive responses to the question of whether presenters should return in AY 2017 and AY 2018, compared with AY 2016. CONCLUSIONS: After implementation of a financial incentive in place of nonclinical time, more faculty became involved in lectures and overall lecture quality improved as measured by resident evaluations.