Disclosing Adverse Events to Patients Wu, Albert W.; McCay, Layla; Levinson, Wendy ...
Journal of patient safety,
2017-March, Letnik:
13, Številka:
1
Journal Article
Recenzirano
OBJECTIVESThere is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of ...this expectation.
METHODSWe reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosurethe United States, the United Kingdom, Canada, New Zealand, and Australia.
RESULTSWe identified 5 themes that reflect key challenges to disclosure(1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure.
CONCLUSIONSPotential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.
Research on mental health following disasters has led to the identification of many individual protective and risk factors for postdisaster mental health. However, there is little understanding of ...the exact influence that disasters have on the functioning of intimate relationships. Especially relevant are attachment styles, which are likely to play an important role in the provision and perception of social support between partners, and subsequent mental health outcomes. Heterosexual couples (N = 127) affected by the 2009 Victorian "Black Saturday" Bushfires in southeastern Australia were surveyed for disaster experiences, posttraumatic stress disorder (PTSD) symptoms, depression, and attachment style between May 2012 and January 2013, approximately 3 years after the disaster. Using actor-partner interdependence models (APIM), we examined both intrapersonal and interpersonal associations of attachment anxiety and avoidance with depression and PTSD, in combination with shared disaster exposure. Male partners' attachment avoidance was associated with depression and PTSD in both partners. By contrast, a female partner's attachment avoidance was associated with greater depression and PTSD in herself, but fewer PTSD symptoms in a male partner. Amid the chronic stressors of a postdisaster setting, the attachment avoidance of the male partner may play a particularly negative role, with his tendency toward isolation and denial becoming especially maladaptive for the couple as a whole. The female partner's attachment avoidance is likewise an important factor, but its associations with negative social support and relationship breakup must be clarified to understand its impact on partnership functioning.
(1) Background: Standard-of-care lifestyle interventions show insufficient effectiveness for the prevention and treatment of excess weight and its associated cardiometabolic health concerns in ...adolescents, necessitating more targeted preventative approaches. Anxiety symptoms are common among adolescents, especially girls at risk for excess weight gain, and have been implicated in the onset and maintenance of disinhibited eating. Thus, decreasing elevated anxiety in this subset of adolescent girls may offer a targeted approach to mitigating disinhibited eating and excess weight gain to prevent future cardiometabolic health problems. (2) Methods: The current paper describes the protocol for a multisite pilot and feasibility randomized controlled trial of group cognitive behavioral therapy (CBT) and group interpersonal psychotherapy (IPT) in
= 40 adolescent girls (age 12-17 years) with elevated anxiety symptoms and body mass index (BMI; kg/m
) ≥ 75th percentile for age/sex. (3) Results: Primary outcomes are multisite feasibility of recruitment, protocol procedures, and data collection, intervention fidelity, retention at follow-ups, and acceptability of interventions and study participation. (4) Conclusions: Findings will inform the protocol for a future fully-powered multisite randomized controlled trial to compare CBT and IPT efficacy for reducing excess weight gain and preventing adverse cardiometabolic trajectories, as well as to evaluate theoretically-informed treatment moderators and mediators.
Charged-current ν_{μ} interactions on carbon, iron, and lead with a final state hadronic system of one or more protons with zero mesons are used to investigate the influence of the nuclear ...environment on quasielasticlike interactions. The transferred four-momentum squared to the target nucleus, Q^{2}, is reconstructed based on the kinematics of the leading proton, and differential cross sections versus Q^{2} and the cross-section ratios of iron, lead, and carbon to scintillator are measured for the first time in a single experiment. The measurements show a dependence on the atomic number. While the quasielasticlike scattering on carbon is compatible with predictions, the trends exhibited by scattering on iron and lead favor a prediction with intranuclear rescattering of hadrons accounted for by a conventional particle cascade treatment. These measurements help discriminate between different models of both initial state nucleons and final state interactions used in the neutrino oscillation experiments.
Short‐term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. ...One relevant factor may be attachment style, which influences patterns of support‐seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3–4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross‐sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
SEPARACIÓN EN RELACIÓN A DESASTRES Y APEGO
La separación por períodos cortos de los miembros de la familia durante un desastre, constituye un evento destacado en los involucrados. Sin embargo, el efecto en la salud mental ha recibido poca atención empírica. Un factor relevante puede ser el estilo de apego, que influencia el patrón de búsqueda de ayuda en condiciones amenazantes. Individuos (N = 914) afectados por el incendio forestal en Victoria, en el sudeste de Australia en 2009, fueron evaluados por experiencias en el desastre, depresión, síntomas de trastorno por estrés postraumático (TEPT) y estilo de apego a los 3 y 4 años después del incendio. Se usó el modelo de ecuaciones estructurales multigrupo para comparar individuos que reportaron separación de sus familias (n = 471), durante el desastre con individuos que no se habían separado de ellas (n = 443). En un corte transversal, los resultados indicaron que los individuos que reportaron separación tuvieron un mayor nivel de síntomas de TEPT. Además, el estilo de apego ansioso fue asociado más fuerte y positivamente con depresión en individuos que reportaron separación (b = 0.62) respecto a individuos que no fueron separados (b = 0.32). Inesperadamente, entre los individuos separados, el estilo evitativo tuvo una asociación estadística débil con depresión (b = 0.17 vs b = 0.35) y síntomas de TEPT (b = 0.06 vs b = 0.22). Estos resultados sugieren que el estilo de apego ansioso amplifica las reacciones negativas relacionadas con separación mientras tanto que los individuos evitativos expuestos a separación en tiempos de peligro, puede facilitar los procesos cognitivos defensivos.
抽象
Traditional and Simplified Chinese s by AsianSTSS
Traditional Chinese
標題: 在災難中經歷分離人士的心理健康:依附形式的影響
撮要: 在災難中跟家庭摯親短暫分離對受影響的人士來說屬顯著事件。可是, 它對人們構成的心理影響卻少有被研究。一個值得研究的有關因素可能是依附形式, 它能影響人在受威脅情況下尋求支援的模式。研究以2009年澳洲東南部的維多利亞森林大火中, 受影響的人士組成樣本(N = 914), 在災難3至4年後評估他們的災難經歷、抑鬱症、創傷後壓力症(PTSD)症狀和依附形式。我們利用多群组結構方程模式, 比較在大火中跟家庭摯親分離的人(n = 471)和沒跟家庭摯親分離的人(n = 443)。橫斷研究結果顯示, 經歷分離的人有較高水平的PTSD症狀。此外, 比起無經歷分離的人(b = 0.32), 經歷分離的人(b = 0.62)當中, 依附焦慮較大程度正向地跟抑鬱症有關。但出乎意料地, 對於經歷分離的人, 迴避依附跟抑鬱症(b = 0.17 對比 b = 0.35)和PTSD症狀(b = 0.06 對比 b = 0.22) 的關連在統計數據上都比無經歷分離的人顯得較弱。研究結果反映, 依附焦慮會擴大分離時的負面反應;而對迴避人士來說, 在危險情況下面對分離有可能構成防衛性的認知過程。
Simplified Chinese
标题: 在灾难中经历分离人士的心理健康:依附形式的影响
撮要: 在灾难中跟家庭挚亲短暂分离对受影响的人士来说属显著事件。可是, 它对人们构成的心理影响却少有被研究。一个值得研究的有关因素可能是依附形式, 它能影响人在受威胁情况下寻求支持的模式。研究以2009年澳洲东南部的维多利亚森林大火中, 受影响的人士组成样本(N = 914), 在灾难3至4年后评估他们的灾难经历、抑郁症、创伤后压力症(PTSD)症状和依附形式。我们利用多群组结构方程模式, 比较在大火中跟家庭挚亲分离的人(n = 471)和没跟家庭挚亲分离的人(n = 443)。横断研究结果显示, 经历分离的人有较高水平的PTSD症状。此外, 比起无经历分离的人(b = 0.32), 经历分离的人(b = 0.62)当中, 依附焦虑较大程度正向地跟抑郁症有关。但出乎意料地, 对于经历分离的人, 回避依附跟抑郁症(b = 0.17 对比 b = 0.35)和PTSD症状(b = 0.06 对比 b = 0.22) 的关连在统计数据上都比无经历分离的人显得较弱。研究结果反映, 依附焦虑会扩大分离时的负面反应;而对回避人士来说, 在危险情况下面对分离有可能构成防卫性的认知过程。
In the disaster literature, psycho-social recovery is conceptualised typically as the alleviation of traumatic stress, with the alleviation of disaster-related grief as a less prominent part of this. ...Yet, incorporating grief understandings into recovery conceptualisations post disaster is important. This paper explores these conceptualisations by analysing participants' bereavement experiences following the Black Saturday bushfires. It draws on data from Beyond Bushfires, a mixed-methods study (n = 1,016) in which survey and interview data relating to individual loss and recovery experiences were examined. The loss through death of friends and community members was found to be predictive of poorer mental health outcomes, although prolonged grief outcomes were rare. The sense of relationshipsas being 'like family' was identified by interviewees as an important dimension of their particuiarcommunities, as was coping with multiple deaths and the hierarchy of grief that emerged, and the stress of notifying others of these deaths. The implications of these impacts are considered for social work research and practice.
This paper presents a case study of Beyond Bushfires, a large, multisite, mixed method study of the psychosocial impacts of major bushfires in Victoria, Australia. A participatory approach was ...employed throughout the study which was led by a team of academic investigators in partnership with service providers and government representatives and used on-site visits and multiple methods of communication with communities across the state to inform decision-making throughout the study. The ethics and impacts of conducting and adapting the approach within a post-disaster context will be discussed in reference to theories and models of participatory health research. The challenges of balancing local interests with state-wide implications will also be explored in the description of the methods of engagement and the study processes and outcomes. Beyond Bushfires demonstrates the feasibility of incorporating participatory methods in large, post-disaster research studies and achieving rigorous findings and multilevel impacts, while recognising the potential for some of the empowering aspects of the participatory experience to be reduced by the scaled-up approach.
Aim
Engagement in social media is increasing. Medical professionals have been adapting LinkedIn, a professional networking site, and Twitter, a microblogging service, for a number of uses. This ...development has been described for a number of medical specialties, but there remains a paucity of European data. A study was undertaken to measure the engagement and activity of German visceral surgeons on social media platforms.
Method
Visceral surgeons were identified from 15 regional Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen) opt‐in registers. A manual search was subsequently performed across key professional social media platforms. The presence of a profile and key markers of use were recorded.
Results
In total, 575 visceral surgeons were identified. 523 (93%) were men. 183 (31%) surgeons engaged in professional social media. 22 (3.8%) used Twitter, producing a mean of 16.43 tweets with a mean of 7.57 followers. 137 (24%) surgeons had a profile on LinkedIn with a mean of 46.36 connections. Female surgeons were less connected on LinkedIn (P < 0.005). 60 (10%) used Xing, with a mean of 27.95 connections. There were no significant differences in use of social media between surgeons from Eastern and Western Germany (P = 0.262) or male and female surgeons (P = 0.399).
Conclusions
German visceral surgeons are less engaged and less active on social media than previously examined cohorts. Loco‐regional, cultural, demographic and regulatory matters may have a significant influence on uptake. If this surgical cohort wishes to have a wider international presence then education on the potential benefits of these tools may be needed.
We sought to assess the experiences and perceptions of healthcare stakeholders involved in the response to historically marginalized patients who have been harmed in healthcare. We investigated the ...challenges in disclosing errors and adverse events and the types of tools and resources that would better address the needs of historically marginalized patient populations.
We conducted separate focus groups with two healthcare stakeholder groups: (1) frontline clinicians directly involved in the clinical care of historically marginalized patients and (2) risk and patient safety professionals involved in the hospital response to care breakdowns. We conducted an inductive analysis of the qualitative data to identify thematic clusters.
We interviewed 7 clinicians and 5 risk safety professionals, with a total sample size of 12 participants. Participants shared multilevel challenges in responding to historically marginalized patients after harm (system-, organizational-, and patient-level), such as fragmentation of care, lack of standardized protocols, and patient mistrust. Participants also identified their desired tools and resources for disclosure to meet the needs of historically marginalized patients, which included culturally appropriate toolkits, disclosure training, and the inclusion of multidisciplinary healthcare team members in the disclosure process.
Our results suggest that multiple interventions will be needed to achieve the goal of prompt disclosure of errors and adverse events across all populations engaged in health care. Future studies should investigate the perspectives of historically marginalized patients and their family members on how error and adverse event disclosure conversations should unfold.
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