Video as a Patient Teaching Tool: Does It Add to the Preoperative Anesthetic Visit? Patient education and informed consent in head and neck surgery. Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control study The use of video before arthroscopic shoulder surgery to enhance patient recall and satisfaction: a randomized-controlled study. The effect of an information brochure on patients undergoing gastrointestinal endoscopy: a randomized controlled study. Patient Satisfaction and Information Gain After the Preanesthetic Visit: A Comparison of Face-to-Face Interview, Brochure, and Video Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate Knowledge retention from preoperative patient information Evaluation of a presurgical group program given at two different times. Patient education videos for elective colorectal surgery: results of a randomized controlled trial Comparative investigation of the effectiveness of face-to-face verbal training and educational pamphlets on readiness of patients before undergoing non-emergency surgeries Physiological, psychological and autonomic responses to pre-operative instructions for patients undergoing cardiac surgery. The Effects of Short Interactive Animation Video Information on Preanesthetic Anxiety, Knowledge, and Interview Time: A Randomized Controlled Trial The Effect of Detailed, Video-Assisted Anesthesia Risk Education on Patient Anxiety and the Duration of the Preanesthetic Interview: A Randomized Controlled Trial Informed consent: the assessment of two structured interview approaches compared to the current approach. Prospective, randomised, controlled trial comparing delivery of patient information for functional endoscopic sinus surgery via website versus printed leaflet. Effects of an informational CD-ROM on anxiety and knowledge before aesthetic surgery: a randomised trial. YouTube Videos to Create a “Virtual Hospital Experience” for Hip and Knee Replacement Patients to Decrease Preoperative Anxiety: A Randomized Trial Informed consent in otologic surgery: prospective study of risk recall by patients and impact of written summaries of risk. The effects of giving patients verbal or written pre-operative information in gynecologic oncology surgery: a randomized study and the medical-legal point of view. The use of a computer website prior to scheduled surgery (a pilot study): impact on patient information, acquisition, anxiety level, and overall satisfaction with anesthesia care. Ambulatory orthopaedic surgery patients' knowledge with internet-based education. Role of pre-operative multimedia video information in allaying anxiety related to spinal anaesthesia: A randomised controlled trial Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. [3-dimensional computer animation--a new medium for supporting patient education before surgery. Acceptance and assessment of patients based on a prospective randomized study--picture versus text]. Prehospital education: effectiveness with total hip replacement surgery patients. Pre‐operative information and patient‐controlled analgesia: much ado about nothing A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Informed consent in otologic surgery: prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout. Multimedia educational interventions for consumers about prescribed and over-the-counter medications.
M eeting the anesthesiologist is one of the surgical patient ’s highest priorities preoperatively ( l ) , and several reports document that this interaction reduces patient anxiety ( 2 - 4 ) . High anxiety may be associated with poorer surgical outcome ( 5 ) , whereas improved patient education is associated with increased patient satisfaction ( 6 ) and improved clinical outcome ( 7 ) . Video instruction may supplement conventional instruction techniques for general medical patients ( 8) and aid in obtaining informed consent ( 9 ) . No study has specifically evaluated an instructional video about anesthesia as a tool for educating surgical patients about their upcoming anesthetic and facilitating the anesthesiologist-patient relationship . The hypothesis of this study is that viewing an anesthesia preoperative video will improve patient knowledge and patient perception of the upcoming anesthetic and surgery compared to a st and ard preoperative interview without video instruction OBJECTIVE To examine the effects of an educational intervention , in the form of printed material , on  patient knowledge and recall of possible risks from  parotidectomy or thyroidectomy .  DESIGN Prospect i ve , r and omized , controlled study conducted during a 9-month period . SETTING Head and neck surgery clinic of an academic tertiary care hospital . PATIENTS One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited . Four patients were excluded from analysis because their follow-up interview was not within the required limits . INTERVENTION At the preoperative visit during the routine consent process , both groups received a verbally delivered checklist of risks specific for the surgery to be performed . The intervention group was also given a pamphlet with written information accompanied by illustrations . MAIN OUTCOME MEASURES The effectiveness of the educational intervention  was determined by comparing the average rate of risk recall between the intervention and control groups . The effects of age , sex , level of education , and time between the consent and recall interviews on recall rate were also assessed . RESULTS The overall risk recall rate for both procedures was 39.1 % . The recall rate of the intervention group was 50.3 % compared with 29.5 % for the control group ( P<.001 ) . CONCLUSIONS The intervention consistently improved risk recall for all patients regardless of age , sex , and level of education . Patients ' ability to recall potential risks was significantly increased by an educational intervention ; all patients would benefit from this intervention Background Informed consent consists of basic five elements : voluntarism , capacity , disclosure , underst and ing , and ultimate decision-making . Physician disclosure , patient underst and ing , and information retention are all essential in the doctor-patient relationship . This is inclusive of helping patients make and manage their decisions and expectations better and also to deal with any consequences and /or complications that arise . This study investigates whether giving patients procedure-specific h and outs pre-operatively as part of the established informed consent process significantly improves overall risk-recall following surgery . These h and outs outline the anticipated peri-operative risks and complications associated with total thyroidectomy , as well as the corrective measures to address complications . In addition , the influence of potential confounders affecting risk-recall , such as anxiety and pre-existing memory disturbance , are also examined . Methods Consecutive adult ( ≥18 years old ) patients undergoing total thyroidectomy at a single academic tertiary care referral centre are included . Participants are r and omly assigned into either the experimental group ( with pamphlets ) or the control group by a computerized r and omization system ( Clinstat ) . All participants filled out a Hospital Anxiety and Depression Scale ( HADS ) and they are tested by the physician for short-term memory loss using the Memory Impairment Screen ( MIS ) exam . All patients are evaluated at one week post-operatively . The written recall question naire test is also administered during this clinical encounter . Results Forty-nine patients are included - 25 of them receive verbal consent only , while another 24 patients received both verbal consent and patient education information pamphlets . The overall average of correct answers for each group was 83 % and 80 % in the control and intervention groups , respectively , with no statistically significant differences . There are also no statistically significant differences between the two groups , in both interview duration , in time between interviews , and in recall tests . No correlation is also apparent between the pre-op HADS score and the recall question naire overall score . Conclusions A pre-operative thyroid surgical information pamphlet alone might not be sufficient to enhance patient test scores and optimally educate the patient on their expected care pathway in thyroid surgery . Supplementation with alternative means of patient education perhaps using emerging technologies needs to be further investigated BACKGROUND Historically , the preoperative consultation has consisted of a discussion between patient and surgeon . There is a growing literature describing efforts to integrate multimedia into surgical patient education . This study aim ed to assess the efficacy of an educational video tutorial on early learning of information specific to patients undergoing shoulder arthroscopy when it was used as an adjunct to the st and ard preoperative consultation . METHODS This study was a surgeon-blinded , r and omized controlled trial involving 40 consecutive patients requiring shoulder arthroscopy . After a preoperative consultation with an orthopaedic surgeon , patients were r and omized in a 1:1 ratio to either a control group or a treatment group . The treatment group viewed a 10-minute video , which covered the expected preoperative , intraoperative , and postoperative experience . Immediately afterward , both groups completed a question naire measuring satisfaction and recall of information received . All patients completed a second question naire at the first postoperative visit that assessed overall satisfaction with their experience . RESULTS Thirty-four patients were available for follow-up . The video group ( N = 15 ) answered 87 % of the knowledge questions correctly , whereas the control group ( N = 19 ) answered only 56 % ( P = .000 ) . There was stronger agreement in the video group that the preoperative consultation contained an appropriate amount of information ( P = .039 ) . Postoperatively , there was agreement that the video was an effective preparation tool for all stages of the surgical experience . However , there was no difference between the groups in satisfaction with their overall surgical experience . CONCLUSIONS Video can enhance patients ' operative experiences and improve their retained knowledge when it is used as an adjunct to the preoperative consultation . LEVEL OF EVIDENCE Basic science , education methodology study , devices to improve learning OBJECTIVE The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time . The information provided was based on self-regulation theory , and patients could restrict themselves to reading the summary only . METHODS Patients were r and omly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy ( N=47 ) , or to a control group not receiving the brochure ( N=48 ) . RESULTS The results show that all experimental subjects , except one , fully read the brochure . Those receiving the brochure experienced less anxiety before the gastroscopy and , afterwards , they reported greater satisfaction with the preparation for it . With regard to coping style there were some small moderating effects into the direction expected : low blunters ( those not seeking distraction under impending threat ) as compared to high blunters showed extra reduced anxiety after reading the brochure . They also tended to read the brochure more often . High monitors ( those seeking information under impending threat ) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors ( tendency ) . CONCLUSION We conclude that providing patients with the developed brochure constitutes an efficient , beneficial intervention . PRACTICE IMPLICATION S The brochure could easily be implemented in st and ard practice without the necessity to take the patient 's coping style into account In this study we compared 3 methods of conducting the preanesthetic visit . We prospect ively studied 197 consecutive surgical patients who were to undergo general anesthesia . The patients were r and omized to a routine preanesthetic interview , a brochure plus an interview , or a self-made documentary video plus an interview . After the preanesthetic visit , the degree of patient satisfaction and information gain was quantified by a question naire for each method . The questions on patient satisfaction were assessed on a six-point scale , and those on information gain were assessed on a multiple-choice basis . The video plus interview group showed the highest point scores ( 98 % of the possible maximum sum point score in patient satisfaction and 93 % of the maximum sum score in information gain ) . In contrast , the patients of the brochure plus interview group revealed 93 % for patient satisfaction and 80 % for information gain , and in the st and ard interview group , the corresponding figures were 91 % and 72 % , respectively . The maximum sum scores in patient satisfaction and information gain were significantly different between the interview and the video groups , but not between the interview and the brochure groups . Therefore , these data suggest that the use of a documentary video to supplement a preoperative interview may enhance patient satisfaction and maximize information gain Purpose The aim of this study was to evaluate the efficacy of a multimedia informed consent ( IC ) presentation on the underst and ing and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate ( HPS-PVP ) . Material s and Methods A multimedia IC ( M-IC ) presentation for HPS-PVP was developed . Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospect ively r and omized to a  conventional written IC group  ( W-IC group , n=20 ) or the M-IC group ( n=20 ) . The allocated IC was obtained by one certified urologist , followed by a 15- question test ( maximum score , 15 ) to evaluate objective underst and ing , and question naires on subjective underst and ing ( range , 0~10 ) and satisfaction ( range , 0~10 ) using a visual analogue scale . Results Demographic characteristics , including age and the highest level of education , did not significantly differ between the two groups . No significant differences were found in scores reflecting the objective underst and ing of HPS-PVP ( 9.9±2.3 vs. 10.6±2.8 , p=0.332 ) or in subjective underst and ing scores ( 7.5±2.1 vs. 8.6±1.7 , p=0.122 ) ; however , the M-IC group showed higher satisfaction scores than the W-IC group ( 7.4±1.7 vs. 8.4±1.5 , p=0.033 ) . After adjusting for age and educational level , the M-IC group still had significantly higher satisfaction scores . Conclusions M-IC did not enhance the objective knowledge of patients regarding this surgical procedure . However , it improved the satisfaction of patients with the IC process itself Background Preoperative education is a common feature of the preoperative preparation for many surgical procedures . It is anticipated that this education will result in beneficial outcomes for the patient . Many studies have evaluated the effectiveness of different formats used to deliver the information , and the effect of this information on a variety of outcomes . While there has been substantial research and several meta‐analyses undertaken on different aspects of preoperative education , there has been no previous attempt to summarise this body of research to evaluate its impact on knowledge and underst and ing of patients . Objective The objective of this review was to present the best available evidence related to knowledge retention and /or correct performance of postoperative activities after preoperative patient education . Review method This review considered all studies that included adults in a hospital setting , either as in patients or same day surgical patients , and who received some form of information and /or instruction before an operative procedure . Interventions were the methods of preoperative patient education , instruction or teaching , and included evaluations of the effectiveness of different presentations such as : written information ; audio‐visual aids ; computer‐assisted instruction ; learning packages in either group or individual formats , at either pre‐admission or post‐admission . The primary outcomes were those associated with the underst and ing of the information related to the operative or postoperative period that were provided in the intervention and included : increased knowledge ; ability to perform postoperative activities ; time to teach skills . This review considered r and omised controlled trials that evaluated forms of preoperative patient education and their effect on patient underst and ing , knowledge and ability to perform postoperative activities . Results The findings of this review support the use of pamphlets to inform patients and to improve their skills . The role of videos as a preoperative instruction tool has not been rigorously evaluated . However , existing studies support the use of preoperative videos to improve patient knowledge and skill . The data suggest that the instructional method , the act of educating a patient by delivering directions for actions or behaviour is useful for improving patients ' knowledge of their treatment and their ability to perform and comply with required exercises . However , instruction is likely to be more effective if provided before admission . If teaching is to be done after admission , using a group format has been shown to be equally as effective as individual instruction . Conclusions Although numerous studies have been performed on many aspects of preoperative education , little high‐ quality research has assessed the effectiveness of this information on patient knowledge and ability to perform specific skills such as exercises . Further research is required to examine : ( i ) the effectiveness of pamphlets and other written material for people with English as a second language or limited literary skills ; ( ii ) the accuracy of information provided in preoperative pamphlets ;  ( iii ) the effectiveness of pamphlets  on  general population s ; ( iv ) the role of videos and learning packages ;  ( v ) the effectiveness of preoperative instruction ; and ( vi ) the changes in patient misconceptions with the provision of preoperative information This study was design ed to test the outcomes of a preoperative teaching program for  cholecystectomy patients and to determine the appropriate time to offer the program . The hypotheses were : ( a ) Patients in a preadmission program  will recover better than those in a program given the eve of surgery , and ( b ) patients in the control group will have a poorer recovery than those in the two experimental groups . The outcomes measured were state-anxiety , ventilatory function , well-being , pain , functional ability , analgesics , and length of hospitalization . There were no significant differences between the three groups except in state-anxiety the eve of surgery which was higher in the control than in the two experimental groups . State-anxiety the eve of surgery and trait-anxiety were the most important variables affecting outcomes . There was a positive and significant linear relationship between pre- and postoperative state-anxiety Recent advances in surgery have focused on peri‐operative care and interventions to improve outcome following surgery . Psychological preparation has a positive impact on recovery and incorporates a range of strategies with dissemination of information as one of the key elements . Information can be given verbally , through printed information or through use of a video . Traditionally , reliance has been on the use of written material as an adjunct to patient education in clinic . The current study is a r and omized trial on the use of video education in patients undergoing elective colorectal resection within an enhanced recovery programme Background : The thought of having a surgery can be stressful for everyone . Providing the necessary information to the patient can help both the patient and the treatment team . This study was conducted to compare the effectiveness of face-to-face verbal training and educational pamphlets on the readiness of patients for undergoing non-emergency surgeries . Material s and Methods : The study was a before – after r and omized clinical trial . 90 patients scheduled to undergo non-emergency surgery who referred to Shahrekord Ayatollah Kashani Hospital in 2013 were distributed r and omly and gradually into two experimental groups ( group of face-to-face verbal training and group of educational pamphlet ) and one control group . Dependent variable of the study was pre-surgery readiness . Data analysis was carried out by using SPSS statistical software . Statistical analysis were analysis of variance ( ANOVA ) and correlation test . Results : Results showed that the mean scores of pre-surgery readiness in both interventional groups were significantly higher than that in the control group after the intervention ( P < 0.05 ) . However , there was no significant difference between the two experimental groups ( P > 0.05 ) . Conclusions : Each of the methods of face-to-face verbal education and using the pamphlet could be equally effective in improving the readiness of the patients undergoing surgery . Therefore , in environments where the health care providers are facing with the pressure of work and lack of sufficient time for face-to-face verbal training , suitable educational pamphlets can be used to provide the necessary information to patients and prepare them for surgery Several studies have reported that the experience may induce emotional reactions before and after surgery . Various Studies have demonstrated that effective pre-operative information reduces stress and anxiety levels . However , little is known about the effect of pre-operative instruction on autonomic responses as measured by heart rate variability ( HRV ) before cardiac surgery . Ninety-one patients were r and omly assigned to video-tape viewing and teaching booklet group . Electrocardiogram was monitored before and after pre-operative instruction . HRV was analyzed with spectral analysis of frequency domains of heart rate and categorized into low and high frequency ( LF and HF ) . After pre-operative instruction , subjects completed a score of perceived stress and helpfulness . In this study , we found that pre-operative instruction with video-tape was similarly effective as teaching booklets on patients ' perceived stress , perceived helpfulness and recovery outcomes . The decrease in HF% and increase in LF/HF ratio of HRV indicate a change in sympathovagal balance toward a lower parasympathetic activity after pre-operative instruction in subjects of both groups . However , the perceived helpfulness of pre-operative instruction may often be associated with a relatively less sympathetic activity . Further studies are needed to determine the optimal timing to enhance the positive effects on the sympathovagal balance after pre-operative instruction BACKGROUND : We design ed an interactive animated video that provides a basic explanation — including the risks , benefits , and alternatives — of anesthetic procedures . We hypothesized that this video would improve patient underst and ing of anesthesia , reduce anxiety , and shorten the interview time . METHODS : Two hundred eleven patients scheduled for cancer surgery under general anesthesia or combined general and epidural anesthesia , who were admitted at least 1 day before the surgery , were r and omly assigned to the video group ( n = 106 ) or the no-video group ( n = 105 ) . The patients in the video group were asked to watch a short interactive animation video in the ward . After watching the video , the patients were visited by an anesthesiologist who performed a preanesthetic interview and routine risk assessment . The patients in the no-video group were also visited by an anesthesiologist , but were not asked to watch the video . In both groups , the patients were asked to complete the State – Trait Anxiety Inventory and a 14-point scale of knowledge test before the anesthesiologist 's visit and on the day of surgery . We also measured interview time . RESULTS : There was no demographic difference between the 2 groups . The interview time was 34.4 % shorter ( video group , 12.2 ± 5.3 minutes , vs. no-video group , 18.6 ± 6.4 minutes ; 95 % confidence interval [ CI ] for the percentage reduction in time : 32.7%– 44.3 % ) , and knowledge of anesthesia was 11.6 % better in the video group ( score 12.5 ± 1.4 vs. no-video group score 11.2 ± 1.7 ; 95 % CI for the percentage increase in knowledge : 8.5%–13.9 % ) . However , there was no difference in preanesthetic anxiety between the 2 groups . CONCLUSION : Our short interactive animation video helped patients ' underst and ing of anesthesia and reduced anesthesiologists ' interview time BACKGROUND : Video-assisted patient education during the preanesthetic clinic visit is a new intervention to increase knowledge transfer to the patient regarding anesthesia procedure and risks . However , little is known about whether video-based patient education influences patient anxiety and the duration of the preanesthetic visit . METHODS : Two hundred nine consecutive patients , who visited the anesthesia clinic before major operations , were r and omly assigned to one of three groups : no-video ( Group 1 ) , video-before-interview ( Group 2 ) , and video-after-interview ( Group 3 ) . Anxiety levels were measured before and after the interview using the  state trait anxiety inventory  and a  visual analog scale ( anxiety ) . Patient knowledge regarding anesthesia technique , anesthesia-related risks , and patient satisfaction were assessed after the interview using st and ardized question naires . RESULTS : There were no significant differences in anxiety levels and patient satisfaction among the three groups . Patient knowledge was significantly higher in the video groups compared with the no-video group . The duration of the preanesthetic interview was significantly extended in Group 2 ( video-before ) ( 23.1 ± 14.0 min ) , compared with Group 1 ( no-video ) ( 17.6 ± 7.2 min ) , and Group 3 ( video-after ) ( 18.3 ± 9.6 min ) . This difference was even more profound in subgroups of patients scheduled for anesthesia techniques with invasive monitoring . CONCLUSION : Our study suggests that the use of a video for detailed anesthesia risk education does not change patient anxiety , but leads to a better underst and ing of the procedure and risks of anesthesia . When the video is shown before the preanesthetic interview , the interview is longer We prospect ively studied 190 patients undergoing tonsillectomy or nasal surgery  to assess the value of two structured interview techniques . There were four groups : Group A did not have a consent interview during the study period . Group B had an informal interview . Group C had a structured interview and Group D had a structured interview and were given an information sheet .  Anxiety assessment s were made and patients ' recall of the operation name , details of the operation and its complications was assessed . Patients had higher than normal anxiety levels when admitted , but several hours after the interview anxiety was normal for Groups B , C and D. Group A maintained a higher anxiety level . Only 37 per cent correctly recalled the operation name , where as 87 per cent of all groups recalled the explanation of the operation . However , Groups C and D recalled a higher mean number of complications per patient . A structured interview when obtaining informed consent increases the number of complications recalled without increasing pre-operative anxiety OBJECTIVE To compare the efficacy of two modes of delivery of information for patients undergoing functional endoscopic sinus surgery :  website and printed leaflet . METHODS A two-centre , prospect i ve , single-blinded , r and omised , controlled trial was conducted , comparing mode of information delivery . Adult patients were r and omly allocated to receive pre-operative information regarding functional endoscopic sinus surgery , either via a website or a printed leaflet . Primary outcomes , measured by question naire , were : readability , usability and recall of complications . RESULTS Fifty-eight patients were recruited . Fifty met the inclusion criteria , of which 40 were analysed in the study ( 20 patients per group ) , meeting the power criteria set . There were 18 male and 22 female patients , ranging in age from 21 to 76 years ( mean , 47 years ) . Patients found both the printed leaflet and the website readable , and were satisfied with the usability of both modes . There were similar rates for recall of complications in both study arms . CONCLUSION Patient information on functional endoscopic sinus surgery can be provided either as a printed leaflet or a website , with similar rates for usability , readability and recall of complications . These findings could help tailor the provision of pre-operative information for patients undergoing functional endoscopic sinus surgery , based on patient preference This trial aim ed to assess the value of visual information by CD ROM before aesthetic breast reduction or abdominoplasty . All included patients were given an information leaflet about the procedure and completed a Spielberger state-trait anxiety inventory ( STAI form Y-1 ) question naire to assess situational anxiety . The patient was then r and omly assigned to watch or not to watch an informational CD ROM . The day before surgery the patient completed a second anxiety question naire and a knowledge question naire . Eighty patients were included , 40 were assigned the CD ROM  and 40 no CD ROM . Patients who watched the CD ROM were significantly less anxious than those who did not ( Mean STAI 45 [ 38.2 - 46.3 ] vs 55 [ 49.9 - 63.8 ] ) . Furthermore they also scored higher in the knowledge question naire as far as the purpose and the procedural details of the surgery were concerned . However , no statistical difference of knowledge regarding the potential complications of the procedure was found Background With declining reimbursement to health care systems , face-to-face time between patients and providers to optimize preoperative education and counseling may be challenging . Objective Because high patient anxiety prior to surgery has been linked to more severe and persistent pain after joint replacement surgery , the Orthopedic Surgery Department at Mayo Clinic in Florida created a playlist of 16 YouTube videos aim ed at creating a virtual hospital experience for primary total hip and knee joint replacement patients . A r and omized trial was then performed to evaluate the potential impact of viewing this playlist on preoperative anxiety . Methods Each patient completed a  Generalized Anxiety Disorder ( GAD ) score assessment at the time of the routine preoperative clinic visit and then r and omized based on his/her gender , type of surgery , and initial GAD score to either the control group of st and ard education ( education at face-to-face clinical visits as well as printed educational material s ) or the treatment group ( st and ard education plus access to the YouTube playlist ) . On the morning of the patient ’s surgery , the same survey was repeated . Of the 65 patients who consented to participate in the study , 53 completed the study ( 82 % ) with 28 of 29 ( 97 % completed ) in the control group and 25 of 36 ( 69 % completed ) in the treatment group . Results Overall , the results showed a trend toward less anxiety in patients who viewed the YouTube videos ; this was exhibited by a reduction in the median GAD score by 1 point . This trend is more clearly present in patients with high preoperative anxiety ( predominantly women ) , as seen in the reduction of the median GAD score by 6 points in the treatment group . Conclusions Although our experience is limited , our results indicate that a series of tailored videos may decrease patient anxiety preoperatively . We recommend further exploration of both this concept and the use of social media tools in preoperative patient education . Trial Registration Clinical trials.gov NCT02546180 ; http:// clinical trials.gov/ct2/show/NCT02546180 ( Archived by WebCite at http://www.webcitation.org/6f6y0Dw7d ) OBJECTIVES To evaluate how much patients  remember of the risks discussed with them about their otologic surgery and to evaluate whether a simple intervention , the addition of an information h and out , improves recall . STUDY DESIGN A prospect i ve , r and omized trial was undertaken in the setting of an academic tertiary care centre . METHODS Fifty patients undergoing a variety of otologic procedures , including mastoidectomy , tympanoplasty , ossiculoplasty , and stapedectomy  , were verbally consented by the operating surgeon with a st and ard checklist of potential surgical complications and side effects . Two surgeons participated in the study ( 40 patients and 10 patients ) . Patients were stratified into two groups : a  higher education group and a lower education group . Within each group , patients were r and omized to either a control group , consisting of a verbal explanation only , or an intervention group , which added a written h and out to the verbal explanation . A follow-up telephone interview was conducted at an average of 20.6 days ( range 14 - 53 ) to survey for recall of the complications discussed . MAIN OUTCOME MEASURES The main outcome measure is risk recall . This is analyzed by education level and written sheet intervention . Other parameters examined are patient demographics , time elapsed from when the consent was obtained , and surgeon obtaining the consent . RESULTS All 50 patients were interviewed in follow-up . Twenty-two patients received the h and out ( intervention arm ) , and 28 patients served as the control group . Overall recall , expressed as a percentage of risks explained , was 54 % for the entire study group . For those who received the h and out , the recall rate was 51 % , whereas the rate was actually higher , at 56 % , for those who did not receive the h and out . This difference was not statistically significant . Of the specific risks discussed , patient recall was consistently high for the complications of facial nerve paralysis , 88 % , and for complete hearing loss , at 88 % . Other risks , such as dizziness , 31 % , and change in taste , 36 % , were not as commonly recalled . Receiving the h and out made only a significant difference with one complication , facial nerve paralysis . CONCLUSION The addition of a h and out did not significantly alter recall of potential complications of otologic surgery with the exception of facial nerve paralysis OBJECTIVES To evaluate the verbal and written preoperative information in patients undergoing surgery for malignant gynaecologic disease , in terms of satisfaction about preoperative received informations , hospitalization days , postoperative pain experienced using visual analogue scale ( VAS ) and number of pain drugs used daily . STUDY DESIGN From January 2008 to December 2012 , consecutive patients with diagnosis of endometrial cancer , referred to the Division of Gynecology of University Campus Bio-Medico of Rome , were enrolled . Eligible subjects were r and omized into two groups : Group V ( Verbal information ward ) consisted of patients who had verbal preoperative information about surgical procedure and postoperative management and Group W ( Written Information ward ) consisted of patients who had written preoperative information . All preoperative and postoperative data were recorded . Concerning satisfaction about preoperative received informations , patients were asked to complete the QLQ-C30 and the EORTC INFO25 . RESULTS 190 patients were considered in this study . Group W ( n=92 ) has a better info satisfaction ( p=0.0008 , statistically significant ) , a mean VAS value lower ( p=0.02 , statistically significant ) and also a lower number of hospitalization days ( p=0.0265 , statistically significant ) and pain medications used daily , ( p=0.0120 , statistically significant ) , comparing with group V ( n=98 ) . CONCLUSIONS We support the use of preoperative information leaflet to better prepare patients for a surgical procedure , showing a faster recovery , low medications use and a better quality of life outcome Scheduled surgery can often be a stressful time for patients . While anesthesia providers give a full explanation of care to the patient , research suggests that anxiety and time constraints imposed by the system may hinder the amount and quality of information provided . Use of technology to augment dissemination of information may have an impact . The purpose of this study was to determine the impact of a website on : ( 1 ) preoperative patient education , ( 2 ) patient anxiety , and ( 3 ) patient satisfaction with anesthesia care . The week prior to surgery , 64 ASA class I and II subjects at a 350-bed urban university affiliated hospital completed a  demographic question naire , State Trait Anxiety Inventory ( STAI ) and modified St and ard Anesthesia Learning Test ( mSALT )  , and the experimental group was given website information . On the day of surgery , all subjects completed the STAI and mSALT . Before discharge , subjects rated satisfaction . The experimental group had a significant increase in posttest mSALT scores ( P = .004 ) . Neither the experimental nor the control group had a significant change in posttest state anxiety ( P = .279 and .762 ) or trait anxiety ( P = .823 and .570 ) . The experimental group differed significantly from the control group in satisfaction with teaching ( P = .019 ) BACKGROUND There is a growing need for patient education and an evaluation of its outcomes . OBJECTIVES The aim of this study was to compare ambulatory orthopaedic surgery patients ' knowledge with Internet-based education and face-to-face education with a nurse . The following hypothesis was proposed : Internet-based patient education ( experiment ) is as effective as face-to-face education with a nurse ( control ) in increasing patients ' level of knowledge and sufficiency of knowledge . In addition , the correlations of demographic variables were tested . METHODS The patients were r and omized to either an  experiment group ( n = 72 ) or a control group ( n = 75 ) . Empirical data were collected with two instruments . RESULTS Patients in both groups showed improvement in their knowledge during their care . Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group . There were no differences in patients ' sufficiency of knowledge between the groups . Knowledge was correlated especially with patients ' age , gender and earlier ambulatory surgeries . CONCLUSIONS As a conclusion , positive results concerning patients ' knowledge could be achieved with the Internet-based education . The Internet is a viable method in ambulatory care Background and Aims : A high incidence of anxiety has been reported in patients in the operation theatre set up . We developed a short visual clip of 206 s duration depicting the procedure of spinal anaesthesia ( SAB ) and aim ed to compare the effect of this video on perioperative anxiety in patients undergoing procedures under SAB . Methods : A prospect i ve r and omised study of 200 patients undergoing surgery under SAB was conducted . Patients were allotted to either the  nonvideo group ( Group NV - those who were not shown the video ) or the video group ( Group V - those who were shown the video ) . Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory during the pre-anaesthetic check-up and before surgery . Haemodynamic parameters such as heart rate ( HR ) and mean arterial pressure ( MAP ) were also noted . Student′s t-test was used for normally distributed and Mann-Whitney U-test for nonnormally distributed quantitative data . Chi-square test was used for categorical data . Results : Both groups were comparable with respect to baseline anxiety scores and haemodynamic parameters . The nonvideo group showed a significant increase in state anxiety scores before administration of SAB ( P < 0.001 ) . Patients in the video group had significantly lower HR and MAP preoperatively ( P < 0.001 ) . The prevalence of ′high anxiety′ for SAB was 81 % in our study which decreased to 66 % in the video group before surgery . Conclusion : Multimedia information in the form of a short audiovisual clip is an effective and feasible method to reduce perioperative anxiety related to SAB The present study examined the association between patient-reported anxiety and postcardiac surgery mortality and major morbidity .  Frailty Assessment Before Cardiac Surgery was a prospect i ve multicenter cohort study of elderly patients undergoing cardiac surgery ( coronary artery bypass surgery and /or valve repair or replacement ) at 4 tertiary care hospitals from 2008 to 2009 . The patients were evaluated a mean of 2 days preoperatively with the  Hospital Anxiety and Depression Scale  , a vali date d question naire assessing depression and anxiety in hospitalized patients . The primary predictor variable was a high level of anxiety , defined by a Hospital Anxiety and Depression Scale score of ≥ 11 . The main outcome measure was all-cause mortality or major morbidity ( e.g. , stroke , renal failure , prolonged ventilation , deep sternal wound infection , or reoperation ) occurring during the index hospitalization . Multivariable logistic regression analysis examined the association between high preoperative anxiety and all-cause mortality/major morbidity , adjusting for the Society of Thoracic Surgeons predicted risk , age , gender , and depression symptoms . A total of 148 patients ( mean age 75.8 ± 4.4 years ; 34 % women ) completed the Hospital Anxiety and Depression Scale . High levels of preoperative anxiety were present in 7 % of patients . No differences were found in the type of surgery and Society of Thoracic Surgeons predicted risk across the preoperative levels of anxiety . After adjusting for potential confounders , high preoperative anxiety was remained independently predictive of postoperative mortality or major morbidity ( odds ratio 5.1 , 95 % confidence interval 1.3 to 20.2 ; p = 0.02 ) . In conclusion , although high levels of anxiety were present in few patients anticipating cardiac surgery , this conferred a strong and independent heightened risk of mortality or major morbidity INTRODUCTION The rigorous implementation of clear preoperative information is m and atory for the patient 's underst and ing , acceptance and written informed consent to all diagnostic and surgical procedures . In the present study , I evaluated whether new media are suitable for conveying basic information to patients ; I analysed the merits of computerized animation to illustrate a difficult treatment process , i.e. , the progressive steps of a thyroid operation , in comparison to the use of conventional flyers . METHODS 3D animation software was employed to illustrate the basic anatomy of the thyroid and the larnyx ; the principle of thyroidectomy was explained by visualizing the surgical procedure step by step . Finally , the possible complications that may result from the intraoperative manipulations were also visually explained . Eighty patients entered a prospect i ve r and omisation : on the day before surgery , group 1 watched the computer animation , whereas group 2 was given the identical information in a written text (= st and ard flyer ) . The evaluation included a question naire with scores of 1 - 5 , rating the patients ' underst and ing , subjective and objective knowledge , emotional factors like anxiety and trust , and the willingness to undergo an operation . RESULT Underst and ing of and subjective knowledge about the surgical procedure and possible complications , the degree of trust in professional treatment , the reduction in anxiety and readiness for the operation were significantly better after watching the computer animation than after reading the text . However , active knowledge did not improve significantly . The interest in the preoperative information was high in both groups . The benefit of  computer animation  was enhanced in a second inquiry ; patients who had only read the text had a significant improvement in parameters after an additional exposure to the video animation . CONCLUSION Preoperative surgical information can be optimized by presenting the operative procedure via computer animation . Nowadays , several types of new media such as the world wide web , CD , DVD , and digital TV are readily available and --as shown here -- suitable for effective visual explanation . Most patients are familiar with acquiring new information by one of these means . An appropriately design ed 3D repre-sentation is met with a high level of acceptance , as the present study clearly shows . Modern patient-based information systems are necessary . They can no longer be the sole responsibility of the medical profession , but must be on the agenda of hospital managements and of medical care systems as well In-hospital education can reduce anxiety , improve coping and shorten hospital stays of surgical patients . However , hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching . This study evaluated prehospital education for total hip replacement ( THR ) surgery . Half of the patients waiting for admission for THR surgery were r and omly selected to receive a THR education booklet  in the mail 4 - 6 weeks before their scheduled THR surgery . Compared to the No-Booklet patients , patients who had received the booklet were less anxious at the time of hospital admission and at discharge , were more likely to have practised physiotherapy exercises prior to hospitalization , and required significantly less occupational therapy and physiotherapy while in hospital . There were no group differences for length of hospital stay We examined whether pre‐operative information benefited patients receiving patient‐controlled analgesia ( PCA ) after major surgery . We investigated whether patients felt better informed about PCA and also whether pre‐operative information altered the use of PCA , the adequacy of pain relief , worries about addiction and safety , and knowledge of side‐effects . We investigated the effectiveness of information provided in two ways , namely by a patient‐determined leaflet or an interview by a trained nurse from the pain team , compared with routine pre‐operative information . We studied 225 patients , 75 in each group . Patients in the leaflet group were better informed about PCA , became familiar with using PCA more quickly and were less confused about PCA than the control group . However , there were no effects on pain relief , worries about addiction and safety , and knowledge of side effects . The pre‐operative interview result ed in no benefits . Our findings indicate that the detailed provision of pre‐operative information failed to improve patients ' experiences of PCA BACKGROUND Patients awaiting cardiac surgery typically experience significant physical and psychological stress . However , although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general , less is known about the effectiveness among patients undergoing cardiac surgery , especially Chinese cardiac patients . OBJECTIVES To determine whether a preoperative education intervention design ed for Chinese cardiac patients can reduce anxiety and improve recovery . DESIGN R and omized controlled trial . SETTING S Cardiac surgical wards of two public hospitals in Luoyang , China . METHODS 153 adult patients undergoing cardiac surgery were r and omized into the trial , 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice . Measurement was conducted before r and omization and at seven days following surgery . The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale ( HADS ) . Secondary outcomes were change in depression ( HADS ) , change in pain as measured by subscales of the Brief Pain Inventory-short form ( BPI-sf ) , length of Intensive Care Unit stay and postoperative hospital stay . RESULTS Of 153 participants r and omized , 135 ( 88.2 % ) completed the trial . Participants who received preoperative education experienced a greater decrease in anxiety score ( mean difference -3.6 points , 95 % confidence interval -4.62 to -2.57 ; P<0.001 ) and a greater decrease in depression score ( mean difference -2.1 points , 95 % CI -3.19 to -0.92 ; P<0.001 ) compared with those who did not . There was no difference between groups in average pain , current pain , and interference in general activity , mood and walking ability . Patients r and omized to the preoperative education group reported less interference from pain in sleeping ( mean difference -0.9 points , 95 % CI -1.63 to -0.16 ; P=0.02 ) . There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients ( P=0.05 ) but no difference in length of postoperative hospital stay ( P=0.17 ) . CONCLUSIONS This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients . Based upon existing evidence and international practice , preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery OBJECTIVE Following consent , do pictures in a h and out improve  patients ' recall of otologic surgical risks ? STUDY DESIGN Prospect i ve , r and omized trial in a tertiary care centre . METHODS Patients undergoing otologic surgery were consented with a st and ardized checklist of risks by two surgeons . They were r and omized ( stratified by educational level ) to receive either a pure text or a text and pictures h and out outlining the risks of surgery . A telephone interview tested recall at a mean of 19 days . Twenty-six patients were re sample d at 1 year . MAIN OUTCOME MEASURES Recall was analyzed with respect to type of h and out , age , sex , and level of education . A subset of 31 patients was analyzed for the effects of which surgeon consented , previous otologic surgery , and actually reading the h and out . RESULTS Fifty-one patients completed the study . The overall risk recall was 43 % , with 45 % in the pictorial group and 42 % in the pure text group ( p = .84 ) . The illustrated h and out did not improve the recall of any individual surgical risk either . Higher education improved risk recall from 36 to 54 % ( p = .009 ) . Age , consenting surgeon , previous otologic surgery , and even reading the h and out did not improve risk recall . A subgroup of 26 patients was followed up 1 year later , and their recall fell from 41 to 35 % . The illustrated h and out did not improve long-term recall ( p = .674 ) . CONCLUSION Pictorial cues do not improve recall of surgical risks , but education level does BACKGROUND Health consumers increasingly want access to accurate , evidence -based information about their medications . Currently , education about medications ( that is , information that is design ed to achieve health or illness related learning ) is provided predominantly via spoken communication between the health provider and consumer , sometimes supplemented with written material s. There is evidence , however , that current educational methods are not meeting consumer needs . Multimedia educational programs offer many potential advantages over traditional forms of education delivery . OBJECTIVES To assess the effects of multimedia patient education interventions about prescribed and over-the-counter medications in people of all ages , including children and carers . SEARCH METHODS We search ed the Cochrane Central Register of Controlled Trials ( CENTRAL , The Cochrane Library 2011 , Issue 6 ) , MEDLINE ( 1950 to June 2011 ) , EMBASE ( 1974 to June 2011 ) , CINAHL ( 1982 to June 2011 ) , PsycINFO ( 1967 to June 2011 ) , ERIC ( 1966 to June 2011 ) , ProQuest Dissertation & Theses Data base ( to June 2011 ) and reference lists of articles . SELECTION CRITERIA R and omised controlled trials ( RCTs ) and quasi- RCTs of multimedia-based patient education about prescribed or over-the-counter medications in people of all ages , including children and carers , if the intervention had been targeted for their use . DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of included studies . Where possible , we contacted study authors to obtain missing information . MAIN RESULTS We identified 24 studies that enrolled a total of 8112 participants . However , there was significant heterogeneity in the comparators used and the outcomes measured , which limited the ability to pool data . Many of the studies did not report sufficient information in their methods to allow judgment of their risk of bias . From the information that was reported , three of the studies had a high risk of selection bias and one was at high risk of bias due to lack of blinding of the outcome assessors . None of the included studies reported the minimum clinical ly important difference for the outcomes that were measured . We have therefore reported results from the studies but have been unable to interpret whether differences were of clinical importance .The main findings of the review are as follows . Knowledge : There is low quality evidence that  multimedia education was more effective than usual care ( non-st and ardised education provided as part of usual clinical care ) or no education ( st and ardised mean difference ( SMD ) 1.04 , 95 % confidence interval ( CI ) 0.49 to 1.58 , six studies with 817 participants ) . There was considerable statistical heterogeneity ( I(2 ) = 89 % ) , however , all but one of the studies favoured the multimedia group . There is moderate quality evidence that multimedia education was not more effective at improving knowledge than control multimedia interventions ( i.e. multimedia programs that do not provide information about the medication ) ( mean difference ( MD ) of knowledge scores 2.78 % , 95 % CI -1.48 to 7.0 , two studies with 568 participants ) . There is moderate quality evidence that multimedia education was more effective when added to a co-intervention ( written information or brief st and ardised instructions provided by a health professional ) compared with the co-intervention alone ( MD of knowledge scores 24.59 % , 95 % CI 22.34 to 26.83 , two studies with 381 participants ) .Skill acquisition : There is moderate quality evidence that  multimedia education  was more effective than usual care  or  no education  ( MD of inhaler technique score 18.32 % , 95 % CI 11.92 to 24.73 , two studies with 94 participants ) and written education ( risk ratio ( RR ) of improved inhaler technique 2.14 , 95 % CI 1.33 to 3.44 , two studies with 164 participants ) . There is very low quality evidence that  multimedia education was equally effective as education by a health professional ( MD of inhaler technique score -1.01 % , 95 % CI -15.75 to 13.72 , three studies with 130 participants ) .Compliance with medications : There is moderate quality evidence that there was no difference between  multimedia education  and usual care or no education ( RR of complying 1.02 , 95 % CI 0.96 to 1.08 , two studies with 4552 participants ) .We could not determine the effect of multimedia education on other outcomes , including patient satisfaction , self-efficacy and health outcomes , due to an inadequate number of studies from which to draw conclusions . AUTHORS ' CONCLUSIONS This review provides evidence that multimedia education about medications is more effective than usual care ( non-st and ardised education provided by health professionals as part of usual clinical care ) or no education , in improving both knowledge and skill acquisition . It also suggests that multimedia education is at least equivalent to other forms of education , including written education and education provided by a health professional . However , this finding is based on often low quality evidence from a small number of trials . Multimedia education about medications could therefore be considered as an adjunct to usual care but there is inadequate evidence to recommend it as a replacement for written education or education by a health professional . Multimedia education may be considered as an alternative to education provided by a health professional , particularly in setting s where provision of detailed education by a health professional is not feasible . More studies evaluating multimedia educational interventions are required in order to increase confidence in the estimate of effect of the intervention . Conclusions regarding the effect of multimedia education were limited by the lack of information provided by study authors about the educational interventions , and variability in their content and quality . Studies testing educational interventions should provide detailed information about the interventions and comparators . Research is required to establish a framework that is specific for the evaluation of the quality of multimedia educational programs . Conclusions were also limited by the heterogeneity in the outcomes reported and the instruments used to measure them . Research is required to identify a core set of outcomes which should be measured when evaluating patient educational interventions . Future research should use consistent , reliable and vali date d outcome measures so that comparisons can be made between studies
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