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.

Collaboration of community hospital endosonographers improves diagnostic yield of endoscopic ultrasonography guided tissue acquisition of solid pancreatic lesions.

Background and study aims Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is the method of choice for establishing a pathological diagnosis of solid pancreatic lesions. Data on quality and yield of EUS-guided TA performed in community hospitals are lacking. A study was performed to determine and improve the diagnostic yield of EUS-guided TA in a group of community hospitals. Methods Following analysis of the last 20 EUS-guided TA procedures of solid pancreatic lesions performed in each of four community hospitals, a collaborative EUS interest group was formed and a prospective registry was started. During meetings of the interest group, feedback on results per center were provided and strategies for improvement were discussed. Results In the BEFORE team formation cohort, 80 procedures were performed in 66 patients. In the AFTER team formation cohort, 133 procedures were performed in 125 patients. After team formation, the rate of adequate sample increased from 80 % (95 %CI [0.7 - 0.9]) to 95 % (95 %CI [0.9 - 1.0]) , diagnostic yield of malignancy improved from 28 % (95 %CI [0.2 - 0.4]) to 64 % (95 % CI [0.6 - 0.7]), and sensitivity of malignancy improved from 63 % (95 %CI [0.4 - 0.8]) to 84 % (95 %CI [0.8 - 0.9]). Multivariate regression analysis revealed team formation to be the only variable significantly associated with an increased rate of adequate sample. Conclusions Formation of a regional EUS interest group with regular feedback on results per center, and discussions on methods and techniques used, significantly improved the outcome of EUS-guided TA procedures in patients with solid pancreatic lesions in community hospitals.

Rivastigmine in Wernicke-Korsakoff's syndrome: five patients with rivastigmine showed no more improvement than five patients without rivastigmine.

AIMS: To evaluate whether rivastigmine, an achetylcholinesterase inhibitor (AChEl), may be effective in restoring memory in Wernicke-Korsakoff's syndrome (WKS). METHODS: Five patients treated with rivastigmine for a period of 6 months were compared with five matched control patients, who received 6 months' conventional treatment, but without rivastigmine. Memory tests were administered at baseline and after 6 months. RESULTS: Slight improvements were observed in both rivastigmine and control patients, but no significant differences in improvements were found between the study groups. CONCLUSION: Treatment with rivastigmine may not be effective in restoring memory in WKS patients.

Confirmatory Factor Analysis of the Dutch Version of the Wechsler Memory Scale-Fourth Edition (WMS-IV-NL).

The latent factor structure of the Dutch version of the Wechsler Memory Scale-Fourth Edition (WMS-IV-NL) was examined with a series of confirmatory factor analyses. As part of the Dutch standardization, 1,188 healthy participants completed the WMS-IV-NL. Four models were tested for the Adult Battery (16-69 years; N = 699), and two models were tested for the Older Adult Battery (65-90 years; N = 489). Results corroborated the presence of three WMS-IV-NL factors in the Adult Battery consisting of Auditory Memory, Visual Memory, and Visual Working Memory. A two-factor model (consisting of Auditory Memory and Visual Memory) provided the best fit for the data of the Older Adult Battery. These findings provide evidence for the structural validity of the WMS-IV-NL, and further support the psychometric integrity of the WMS-IV.