The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study.

BACKGROUND: Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. METHODS: A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2-4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. RESULTS: Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2-4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. CONCLUSION: Teach-back is an efficient and non-time-consuming method to improve patients' immediate and short-term recall and comprehension of discharge information in the ED.

Clinical evaluation vs magnetic resonance imaging of the skier's thumb: A prospective cohort of 30 patients.

INTRODUCTION: A skiers thumb, or a partial or complete rupture of the ulnar collateral ligament (UCL) is a clinical diagnosis. Swelling, pain, natural left-right difference and inexperience of a young physician can cause difficulty to correctly diagnose this injury. However, our theory is that any physician, given the correct instructions, should be able to diagnose this injury solely on clinical findings, without the necessity of additional imaging. MATERIAL AND METHODS: In a large Dutch teaching hospital, physicians (residents with working experience of 6months-3years) working at the ER received instructions for physical examination. Patients >18 years, with an injury <1 week old, suspected of a true skier's thumb had an MRI reported by two independent radiologists to confirm the diagnosis. RESULTS: Thirty patients were included. Seven patients had no fixed endpoint (23%), all had a complete ligamentous rupture of the UCL on MRI, of which three patients had a Stener lesion. Fifteen patients (50%) met with the criteria >35° laxity in extension of MCP/ >20° laxity in 30° flexion of the MCP. Of these, thirteen patients (81%) had a complete rupture (nine Stener lesions (56%)). One patient had a partial injury and one patient had no UCL-injury. Eight patients (27%) had inconclusive results during physical examination. Of these, two had a complete rupture (40%, 1 Stener). Three patients had a partial rupture and three patients had an intact UCL. CONCLUSION: A skier's thumb can be diagnosed by any resident when correctly instructed. Additional imaging when diagnosing a skier's thumb should be reserved in cases when physical examination remains inconclusive.

[A man with an ulcerating swelling on the throat]. / Een man met een ulcererende zwelling in de hals.

A 66-year-old man had a dry ulcerating swelling on the throat with progressive growth. In the previous year, he had had neoadjuvant chemoradiotherapy and an operative resection of oesophagus carcinoma. Biopsy revealed a metastasis of the oesophagus carcinoma. Skin metastases of oesophagus carcinoma are rare and respond well to chemotherapy.

[Skier's thumb]. / De skiduim.

Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an injury that rather frequently occurs in certain sports. When diagnosed incorrectly, delay in treatment can ultimately lead to chronic instability and pain. Correct knowledge of the anatomy and method of physical examination is essential when assessing a patient suspected of having skier's thumb. This article describes three different types and treatment of skier's thumb, and further describes the relevant anatomy, correct physical examination, available additional imaging and various treatments possible.

Rupture of the ulnar collateral ligament of the thumb - a review.

Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging and treatment with attention to possible pitfalls.