Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI)

Background Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI). Objectives We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI. Methods In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group, n  = 153) or sham information (Control group, n  = 148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA). Results Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2–1.8); p  < 0.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4–2.2), p  < 0.001]. Mean STAI score declined by 5.7 (95% CI 5.1–6.3; p  < 0.001) in the Comic and 0.8 points (0.2–1.4; p  = 0.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8–5.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function ( p  < 0.001 each). Conclusions Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23/Oct/2020)

The human capital transition and the role of policy

Along with information and communication technology, infrastructure, and the innovation system, human capital is a key pillar of the knowledge economy with its scope for increasing returns. With this in mind, the purpose of this chapter is to investigate how industrialized economies managed to achieve the transition from low to high levels of human capital. The first phase of the human capital transition was the result of the interaction of supply and demand, triggered by technological change and boosted by the demands for (immaterial) services. The second phase of the human capital transition (i.e., mass education) resulted from enforced legislation and major public investment. The state’s aim to influence children’s beliefs appears to have been a key driver in public investment. Nevertheless, the roles governments played differed according to the developmental status and inherent socioeconomic and political characteristics of their countries. These features of the human capital transition highlight the importance of understanding governments’ incentives and roles in transitions

Human Capital Accumulation in France at the Dawn of the Nineteenth Century : Lessons from the Guizot Inquiry

International audienceBuilding on the results of the Guizot inquiry, carried out in autumn 1833 on the initiative of François Guizot, the minister of public instruction, this article examines the process of human capital accumulation in the early nineteenth-century France. We rely on an original measure of human capital—student progress—to highlight the high level of heterogeneity in human capital accumulation in this period. We identify two types of schools in the French educational landscape: first, large schools, well-endowed in human and material resources, which contributed a great deal to human capital accumulation, and, second, small schools, characterised by some degree of amateurism and improvisation, which weakly contributed to human capital formation. We note that the use of literacy rates or school enrolment rates can be misleading with regard to the estimation of French human capital endowments, laying emphasis instead on the heterogeneity in the French educational landscape at the dawn of the nineteenth century, as the country embarked on the process of industrialisation