Background Some hospitals’ and health systems’ websites report physician-level ratings and comments drawn from the Consumer Assessment of Healthcare Providers and Systems surveys. Objective The aim was to examine the prevalence and content of health system websites reporting these data and compare narratives from these sites to narratives from commercial physician-rating sites. Methods We identified health system websites active between June 1 and 30, 2016, that posted clinician reviews. For 140 randomly selected clinicians, we extracted the number of star ratings and narrative comments. We conducted a qualitative analysis of a random sample of these physicians’ narrative reviews and compared these to a random sample of reviews from commercial physician-rating websites. We described composite quantitative scores for sampled physicians and compared the frequency of themes between reviews drawn from health systems’ and commercial physician-rating websites. Results We identified 42 health systems that published composite star ratings (42/42, 100%) or narratives (33/42, 79%). Most (27/42, 64%) stated that they excluded narratives deemed offensive. Of 140 clinicians, the majority had composite scores listed (star ratings: 122/140, 87.1%; narrative reviews: 114/140, 81.4%), with medians of 110 star ratings (IQR 42-175) and 25.5 (IQR 13-48) narratives. The rating median was 4.8 (IQR 4.7-4.9) out of five stars, and no clinician had a score less than 4.2. Compared to commercial physician-rating websites, we found significantly fewer negative comments on health system websites (35.5%, 76/214 vs 12.8%, 72/561, respectively; P <.001). Conclusions The lack of variation in star ratings on health system sites may make it difficult to differentiate between clinicians. Most health systems report that they remove offensive comments, and we notably found fewer negative comments on health system websites compared to commercial physician-rating sites.
In this study, we sought to examine the effect of experimentally-induced somatic pain on memory. Subjects heard a series of words and made categorization decisions in two different conditions. One condition included painful shocks administered just after presentation of some of the words; the other condition involved no shocks. For the condition that included painful stimulations, every other word was followed by a shock, and subjects were informed to expect this pattern. Word lists were repeated three times within each condition in randomized order, with different category judgments but consistent pain-word pairings. After a brief delay, recognition memory was assessed. Non-pain words from the pain condition were less strongly encoded than non-pain words from the completely pain-free condition. Recognition of pain-paired words was not significantly different than either subgroup of non-pain words. An important accompanying finding is that response times to repeated experimental items were slower for non-pain words from the pain condition, compared to non-pain words from the completely pain-free condition. This demonstrates that the effect of pain on memory may generalize to non-pain items experienced in the same experimental context.
Background Despite the well-known clinical effects of midazolam and ketamine, including sedation and memory impairment, the neural mechanisms of these distinct drugs in humans are incompletely understood. The authors hypothesized that both drugs would decrease recollection memory, task-related brain activity, and long-range connectivity between components of the brain systems for memory encoding, pain processing, and fear learning. Methods In this randomized within-subject crossover study of 26 healthy adults, the authors used behavioral measures and functional magnetic resonance imaging to study these two anesthetics, at sedative doses, in an experimental memory paradigm using periodic pain. The primary outcome, recollection memory performance, was quantified with d′ (a difference of z scores between successful recognition versus false identifications). Secondary outcomes were familiarity memory performance, serial task response times, task-related brain responses, and underlying brain connectivity from 17 preselected anatomical seed regions. All measures were determined under saline and steady-state concentrations of the drugs. Results Recollection memory was reduced under midazolam (median [95% CI], d′ = 0.73 [0.43 to 1.02]) compared with saline (d′ = 1.78 [1.61 to 1.96]) and ketamine (d′ = 1.55 [1.12 to 1.97]; P < 0.0001). Task-related brain activity was detected under saline in areas involved in memory, pain, and fear, particularly the hippocampus, insula, and amygdala. Compared with saline, midazolam increased functional connectivity to 20 brain areas and decreased to 8, from seed regions in the precuneus, posterior cingulate, and left insula. Compared with saline, ketamine decreased connectivity to 17 brain areas and increased to 2, from 8 seed regions including the hippocampus, parahippocampus, amygdala, and anterior and primary somatosensory cortex. Conclusions Painful stimulation during light sedation with midazolam, but not ketamine, can be accompanied by increased coherence in brain connectivity, even though details are less likely to be recollected as explicit memories. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Abstract:In this study, we sought to examine the effect of pain on memory. Subjects heard a series of words and made categorization decisions in two different contexts. One context included painful shocks administered just after presentation of some of the words; the other context involved no shocks. For the context that included painful stimulations, every other word was followed by a shock and subjects were informed to expect this pattern. Word lists were repeated three times within each context in randomized order, with different category judgments but consistent pain-word pairings. After a brief delay, recognition memory was assessed. Non-pain words from the pain context were less strongly encoded than non-pain words from the completely pain-free context. An important accompanying finding is that response times to repeated experimental items were slower for non-pain words from the pain context, compared to non-pain words from the completely pain-free context. This demonstrates that the effect of pain on memory may generalize to non-pain items experienced in the same experimental context. Introduction:The experience of acute somatic pain is often memorable. Aside from the memory of pain itself, noxious stimuli can affect learning and memory in several important ways. Brief painful experiences can enhance learning. After touching a hot stove, for example, an individual typically forms strong memories of the experience and learns to avoid this behavior in the future. However, the relationship between pain and memory is nuanced, and everyday examples of pain impairing memory are also common. Protracted pain can interfere with concentration and the ability to recall specific details of events that occur, for example, during a severe headache. Thus, the effect of pain on memory may depend on the context in which encoding occurs. Despite how commonplace such experiences are, empirical evidence quantifying pain's effect on memory is limited.
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