The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention.

BACKGROUND: Psychoactive substances have toxic effects resulting different cardiovascular and non-cardiovascular organ damage. Through a variety of mechanisms, they can trigger the onset of various forms of cardiovascular disease: acute or chronic, transient or permanent, subclinical or symptomatic. Hence, a thorough knowledge of the patient's drug habits is essential for a more complete clinical-etiopathogenetic diagnosis and consequent therapeutic, preventive, and rehabilitative management. SUMMARY: The prime reason for taking a psychoactive substance use history in the cardiovascular context is to identify those people who use substances (whether habitual or occasional users, symptomatic or not) and adequately assess their overall cardiovascular risk profile in terms of "user status" and type of substance(s) used. A psychoactive substance history could also alert the physician to suspect, and eventually diagnose, cardiovascular disease related to the intake of psychoactive substances, so optimizing the medical management of users. This anamnesis could finally assess the likelihood of patients persisting in the habit as a user or relapse, while maintaining high their cardiovascular risk profile. Taking such a history should be mandatory when a causal connection is suspected between intake of psychoactive substances and the observed symptoms or pathology, regardless of whether the individual is a declared user or not. KEY MESSAGES: The purpose of this article was to provide practical information on when, how, and why to perform a psychoactive substance use history.

Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers.

Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters.

Temporal uncertainty in disease diagnosis.

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person's health. This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics.

A laboratory medical anamnesis interview elicits psychological and physiological arousal.

Since medical communication can be perceived as stressful, the assessment of patients' physiological arousal and behavior during anamnesis interviews may lead to a better understanding of doctor-patient interactions. Therefore, the aim of this study was to test physiological arousal and word use in a laboratory anamnesis interview. In total, sixty-five participants with a mean age of 25.0 years were randomly assigned either to an experimental group (n = 35, 65.7% women) in which they underwent an anamnesis interview or to a control group (n = 30, 73.3% women). Physiological arousal was assessed by salivary cortisol, salivary alpha-amylase (sAA), heart rate (HR) and heart rate variability (HRV). Psychological arousal was assessed using the Positive and Negative Affect Schedule (PANAS). Anamnesis interviews were analyzed using the Linguistic Inquiry and Word Count text analysis tool (LIWC). Participants of the experimental group showed an increase of sAA, HR and negative affect (p's ≤.0.05). Moreover, higher cortisol area under the curve with respect to ground (AUCg) was associated with lesser use of positive emotion words during the interview and subsequent higher negative affect (p's <.05). These results indicate that talking about one's own and family's medical history in anamnesis interview induces physiological arousal. Our findings suggest that anamnesis interviews could not only induce higher negative affect, but also induce physiological arousal, underscoring the importance of good doctor-patient communication.

Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review.

BACKGROUND: Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians' ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician. OBJECTIVE: Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. METHODS: We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators. RESULTS: We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care. CONCLUSIONS: The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.

[Generalized seizure during placement of an axillary plexus block]. / Generalisierter Krampfanfall während der Anlage einer axillären Plexusblockade.

A young patient experienced a generalized seizure during the placement of an axillary plexus block. The mechanisms, essentially the presumed intravascular administration, which led to the local anesthetic toxicity as the cause of this event, are discussed. This case is an example of how visualization of the anatomy by ultrasound can give a false impression when certain details are not respected. It is assumed that the main mechanism in this case was venous compression by the ultrasound transducer.

[Overlooked compartment syndrome of the hand after burn injury and known polytoxicomania]. / Übersehenes Kompartmentsyndrom an der Hand nach Brandverletzung und bekannter Polytoxikomanie.

A young man suffered the fatal combination of burn injuries and acute kidney failure caused by substantial rhabdomyolysis after lying on the floor in a somnolent condition for 12 h. This symptom constellation should always make physicians aware of a potential compartment syndrome.

[Exploration and consideration of media problems in the psychotherapy of adults: An online survey of psychotherapists]. / Exploration und Berücksichtigung von Medienproblemen in der Psychotherapie von Erwachsenen: Eine Online- Befragung von Psychotherapeut*innen.

Exploration and consideration of media problems in the psychotherapy of adults: An online survey of psychotherapists Background: The inclusion of media-related behavioral addictions in DSM-5 and ICD-11 indicates the necessity of media anamnesis as secondary prevention (early detection) in psychotherapy. Objectives: The aim of the study was to document the extent of media problems in therapeutic practice and to identify factors related to exploration (media anamnesis). Method: Using an online survey (11/2019-03/2020), N = 160 psychotherapists from Germany and Austria were interviewed. Design: a self-constructed questionnaire plus standardised scales, i. e. subscales E1 and E2 of Therapeutic Identity Questionnaire (ThId), scales for affinity to techniques (TA-EG) and personality (BFI-10). Results: Of the participating psychotherapists 60 % reported patients with media-issues, of which (54 %) consider themselves competent in respective treatment, 72 % did not participate in further training; however, the ones attended did not feel competent of handling media-issues in psychotherapy after training. Two thirds (63 %) did not/rather did not explore media consumption in anamnesis and treatment. The exploration of media consumption was significantly related to specific training, the personality dimensions neuroticism and openness, and an affinity for technology. Conclusions: Current further training courses do not meet the needs of psychotherapists and should be adapted. The personality dimensions of the psychotherapists play a role in handling media problems in psychotherapy.

Current clinical practice in disabling and chronic migraine in the primary care setting: results from the European My-LIFE anamnesis survey.

BACKGROUND: Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migraine patients often remains suboptimal, especially for chronic migraine (CM) patients. METHODS: My-LIFE anamnesis project surveyed 201 General practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain, and the UK) with the aim of understanding chronic migraine (CM) patients' management in the primary care setting. RESULTS: In our survey, GPs diagnosed episodic migraine (EM) more often than CM (87% vs 61%, p < 0.001). We found that many CM patients were not properly managed or referred to specialists, in contrast to guidelines recommendations. The main tools used by primary-care physicians included clinical interview, anamnesis guide, and patient diary. Tools used at the first visit differed from those used at follow-up visits. Up to 82% of GPs reported being responsible for management of patients diagnosed with disabling or CM and did not refer them to a specialist. Even when the GP had reported referring CM patients to a specialist, 97% of them were responsible for their follow-up. Moreover, the treatment prescribed, both acute and preventive, was not in accordance with local and international recommendations. GPs reported that they evaluated the efficacy of the treatment prescribed mainly through patient perception, and the frequency of follow-up visits was not clearly established in the primary care setting. These results suggest that CM is underdiagnosed and undertreated; thereby its management is suboptimal in the primary care. CONCLUSIONS: There is a need of guidance in the primary care setting to both leverage the management of CM patients and earlier referral to specialists, when appropriate.

A pilot study of patient satisfaction with a self-completed tablet-based digital questionnaire for collecting the patient's medical history in an emergency department.

BACKGROUND: The increasing popularity and availability of tablet computers raises questions regarding clinical scenarios. This pilot study examined the patient's satisfaction when using a tablet-based digital questionnaire as a tool for obtaining medical history in an emergency department and to what extent gender, age, technical competence and mother tongue influence the user satisfaction. Patients were asked to complete three consecutive questionnaires: The first questionnaire collected basic epidemiological data to measure past digital usage behaviour, the second questionnaire collected the patient's medical history, and the third questionnaire assessed the overall perceived user satisfaction when using the tablet-based survey application for medical anamnesis. RESULTS: Of 111 consenting patients, 86 completed all three questionnaires. In summary, the user evaluation was positive with 97.7% (n = 84) of the patients stating that they had no major difficulties using the digital questionnaire. Only 8.1% (n = 7) of patients reported a preference to fill out a paper-and-pen version on the next visit instead, while 98.8% (n = 85) stated that they would feel confident filling out a digital questionnaire on the next visit. The variables gender, age, mother tongue and/or technical competence did not exert a statistically significant influence towards the defined scales usability, content and overall impression. CONCLUSION: In conclusion, self-administered tablet-based questionnaires are widely accepted tools for collecting medical information in the emergency room across all ages and genders, regardless of technical competence.

Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey.

BACKGROUND: Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed. METHODS: An international, online survey was conducted among 201 general practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain and the UK) who are experienced in the management of headache disorders. RESULTS: The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists. Among those patients, the participants estimated that around 55% received preventive medication. Some differences between countries were observed regarding referral rate and prescription of preventive treatment. Most GPs (87%) reported a lack of training or the need to be updated on CM management. Accordingly, 95% of GPs considered that a migraine anamnesis guide could be of use. Overall, more than 95% of GPs favoured the use of a patient diary, a validated diagnostic tool and a validated scale to assess impact of migraine on patients' daily life. Similarly, 96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations. CONCLUSIONS: The results from this survey indicate that more education on diagnosis and management of CM is needed in primary care. Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients' lives, healthcare utilization and societal burden.

Anamnesis as a Prognostic Factor in Cochlear Implantation in Adults.

INTRODUCTION: This study aims to analyze possible preoperative factors taken from the medical history that may assist the otolaryngologist in counseling an adult patient before cochlear implantation (CI). OBJECTIVE: Analysis of preoperative factors taken during the initial patient presentation for a possible prognostic role in the auditory rehabilitation outcome. METHODS: A cohort of 232 (272 CI implantations) postlingually deafened adults was evaluated in this study. Hearing results at 1, 2, and up to 3 years postoperatively were compared with various preoperative factors: living status, cause of deafness, gender, side of implantation, residual hearing, and duration of deafness. Postoperative hearing performance was measured based on the German Freiburg monosyllabic word test and the Oldenburg sentence test. RESULTS: Duration of deafness showed a negative correlation to word recognition and a positive correlation to increased speech reception threshold in sentence testing. A significant decline in hearing outcome was shown starting around the second decade of deafness. Residual hearing as defined in our cohort and side of implantation showed limited benefit in speech understanding. Living status, gender, and cause of deafness did not show any prognostic value. CONCLUSION: In this retrospective review it could be shown that simple case history information can only provide limited prognostic insight before CI. The duration of deafness is the most reliable anamnestic factor present on initial patient evaluation.

Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value.

The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as "red flags" (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients' interactions and reporting towards decisive aspects.

[Which complementary examination does replace a bad clinical examination ? A good clinical examination ! A mood ticket...] / Quel examen complémentaire remplace un mauvais examen clinique ? Un bon examen clinique ! Billet d'humeur

The writer rebels in a mood ticket on the dictatorship of the complementary examinations at the expense of the clinical approach. She comments on the multiple reasons, medical and medicolegal, which in the 21st century still encourages a good history taking and a good clinical examination.

L'auteure s'insurge, dans un billet d'humeur, sur la dictature des examens complémentaires aux dépens de la clinique. Elle commente les multiples raisons, médicales et médicolégales qui doivent, au XXIème siècle, toujours inciter à une bonne anamnèse et un bon examen clinique.

[Diagnostics of acute and chronic back pain]. / Diagnostik von akuten und chronischen Rückenschmerzen.

BACKGROUND: Back pain is ranked as the fourth highest medical expense per year. The number of affected patients is constantly increasing because of increasing chronification due to insufficient recognition of the cause. METHODS: The diagnosis of back pain is based on three important pillars. On the one hand, a detailed anamnesis and correct clinical examination by the responsible physician is extremely important, followed by an experienced radiologist who is responsible for determining the imaged-based ethiology of the symptoms. RESULTS/CONCLUSION: Anamnesis and clinical examination play an important role in identifying patients with a real underlying pathology for the symptomatology in order to provide them with direct imaging for further evaluation. Corresponding pathology in most cases of acute back pain is generally not found but here psychosocial factors ("yellow flags") are in the foreground. Attention should always be paid to the presence of "red flags" and the possibility of extraspinal causes.

New insights into the clinical signs of supraventricular tachycardia: The "sign of lace-tying".

BACKGROUND: Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy. METHODS: This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the "sign of lace-tying" that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay. RESULTS: Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the "sign of lace-tying." Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT. CONCLUSIONS: Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the "sign of lace-tying" or body position change before SVT, implying a diagnosis of SVT.

[Epidemiological features of parasitary invasis in women of reproductive age with disorders of reproductive health].

OBJECTIVE: The aim: The purpose of this study is to analyze the frequency and structure of parasitic lesion in women with reproductive health disorders. PATIENTS AND METHODS: Materials and methods: The immune-enzyme method tested immunoglobulins IgG to ascaris, lamblia, toxocara. Determination of the presence of pinworm eggs (sticky tape and perianal scrape method) and ascarid (methods of K.Cato, F.Fueleborna and E.S.Schulman). RESULTS: Results: In women with complicated obstetric anamnesis, parasitic invasions occurred in (52.3 ± 5.0)% (Χ² = 34.9, p <0.01; 95% CI = 42.5-62.1). Enterobiasis was detected in (12,0 ± 3,3)% of patients, acarida eggs in (29,3 ± 4,6)%, positive titers of IgG to ascaris - in (11.5 ± 3.2)%, IgG to lamblia in - 7.5%, IgG to toxocara 3.5%, the combined detection - in (11.5 ± 3.2)% of the examined group. In patients of the control group, parasitic invasions were detected in (13.1 ± 3.4)%. The prevalence of parasitic lesion in women with primary infertility (58.0 ± 4.9)% (OR = 8.9; 95% CI = 5.2-15.3; p <0.01), in planning pregnancy (25, 7 ± 4.4)% (OR = 2.3, 95% CI = 1.3-4.0). The most significant aggressive parasite in women with complicated obstetric anamnesis, reproductive loss and infertility is ascariasis (95% CI 6.1-38; p <0.001). In women with parasitic lesion revealed the dominance of pathology of the mammary glands, gastrointestinal tract, acne, pathology of the urinary system, thyroid gland. CONCLUSION: Conclusions: The obtained results make it possible to recommend parasite examination in women with infertility and complicated obstetric anamnesis.

[Dental care for patients at risk of adverse reaction to local anesthetics]. / Stomatologicheskaia pomoshch' patsientam s riskom razvitiia pobochnykh reaktsii na mestnye anestetiki.

The study comprised 53 patients with side effect history to local anesthetics. The reasons for the occurrence of adverse reactions to local anesthetics was analyzed, and the frequency of their occurrence in dental practice was studied. It was found that in most patients (85%) with 'allergic reactions' to local anesthetics the diagnosis was unreasonable and incompetent. In most cases psychosomatic reactions were mistaken for an immediate allergic reaction. The prevalence of adverse reactions to local anesthetics was 1 case per 448 injections (1:448), true allergic reactions was documented in 0.1% cases.

Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly.

BACKGROUND: There is common agreement in the literature that it can result in an underestimation of benign paroxysmal positional vertigo (BPPV) in the elderly. AIMS: The aim of this work was to analyze the role of anamnesis in the diagnosis of BPPV in patients of different ages through the development and validation of a scored questionnaire. METHODS: The questionnaire is based on the presence/absence of six typical anamnestic features of BPPV. The Mini-Mental State Exam (MMS) was also administered to patients over 65 years of age. Bedsides, examination for BPPV was then carried out, assigning the outcome of the questionnaire and eventual MMS to the final diagnosis for each patient. RESULTS: The sensitivity and specificity of the questionnaire for high scores (>8) were found to be, respectively, 86 % and 80 % in all patients, 94 and 71 % in those under 65 years of age, 78 and 90 % in patients over 65, and, in particular, 63 and 83 % in those with MMS >24 and 100 and 100 % in those with MMS ≤24. DISCUSSION: The reliability and average score of the questionnaire were statistically significantly lower in the group of elderly patients without cognitive deficits. The lower reliability of the questionnaire in the geriatric population, rather than the presence of cognitive deterioration, seems to correlate with other comorbidities or simply to a lower mobility of the head triggering positional symptoms. CONCLUSION: The use of the questionnaire could however reduce the risk of a missed diagnosis of BPPV given its good reliability across all ages.

Drug List as a Cognitive Support to Provide Detailed Information on a Patient's Drug Use: A Comparison of Two Methods Within the Assessment of Drug Misuse and Dependence.

BACKGROUND: It is important to identify the type of drugs a patient has used, especially when polydrug misuse has increased and new drugs and patterns of misuse are quickly spread. OBJECTIVES: In order to acquire sufficient information about drug use, an effective and simple form of mapping is needed. METHODS: Persons actualized for Opioid Substitution Treatment (n = 135) were interviewed about their drug-history in a two-stage model. First, they were asked to write down the drugs misused, and dot those injected with a felt pen. Second, they were asked to do the same on a drug list provided as a cognitive support. For a subsample of 50 persons, the drug list included four fictive drugs to evaluate possible over-reporting. RESULTS: The use of a drug list did not take longer than the traditional way of using open questions, i.e. about 5-8 minutes. Using a drug list gave a cognitive support resulting in a much higher proportion/number of reported drugs. The majority, 97%, used more than one drug. None of the patients who were given the drug list that included fictive drug names reported having used any of them. The respondents reported 43 additional substances to the 125 given on the list which improve our knowledge of the drug scene. CONCLUSIONS/IMPORTANCE: Using a drug-list was superior to open questions; it does not take more time and provides additional, clinically relevant information than open questions. Using a drug-list also gives improved knowledge of new drugs entering the local drug scene.