Context.-Medical errors are unfortunately common.The US Institute of Medicine proposed guidelines for mitigating and disclosing errors. Implementing these recommendations in pathology will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists' experiences with and attitudes toward disclosure of medical error.Objective.-To understand pathologists' attitudes toward disclosing pathology error to treating clinicians and patients.Design.-We conducted 5 structured focus groups in Washington State and Missouri with 45 pathologists in academic and community practice. Participants were questioned about pathology errors, how clinicians respond to pathology errors, and what roles pathologists should play in error disclosure to patients.Results.-These pathologists believe that neither treating physicians nor patients understand the subtleties and limitations of pathologic diagnoses, which complicates discussions about pathology errors. Pathologists' lack of confidence in communication skills and fear of being misrepresented or misunderstood are major barriers to their participation in disclosure discussions. Pathologists see potential for their future involvement in disclosing error to patients, but at present advocate reliance on treating clinicians to disclose pathology errors to patients. Most group members believed that going forward pathologists should offer to participate more actively in error disclosure to patients.Conclusions.-Pathologists lack confidence in error disclosure communication skills with both treating physicians and patients. Improved communication between pathologists and treating physicians could enhance transparency and promote disclosure of pathology errors. Consensus guidelines for best practices in pathology error disclosure may be useful.(Arch Pathol Lab Med. 2017;141:841-845; doi: 10.5858/ arpa.2016-0136-OA) C ommunicating to patients that a harmful error has occurred in their care is a daunting task for any physician.1 The recent Institute of Medicine (IOM) report on diagnostic error emphasized the importance of communication and error disclosure in medicine. The report details tactics for effective communication of error.2 Despite widespread recognition of the ethical mandate for complete disclosure of medical errors, recent studies indicate that error disclosure happens less frequently than it should and patients often report dissatisfaction with the information, apology, and resolution provided. [3][4][5][6][7][8][9] Failure to completely disclose medical errors can lead to emotional distress for patients and physicians, patient feelings of vulnerability and abandonment, and increased likelihood of malpractice litigation. 10When harmful error involves pathology, the disclosure situation becomes more complex than when error involves only the patient's direct care team. Pathologists do not have established relationships with patients, and patients are usually unaware of the role of pat...
INTRODUCTION: Hepatitis C virus (HCV) infection affects thousands of pregnancies in the U.S. each year, yet there is a relative paucity of data on the outcomes of pregnancies complicated by the virus. This study analyzes recent, nationwide data on complications of pregnancy in the setting of HCV infection. METHODS: This retrospective cohort study examined 10,457,976 singleton deliveries in the U.S. between 2011-2013. Simple proportions of obstetric complications were compared between pregnancies complicated by Hepatitis C infection and controls. Chi squared tests and multivariable regression were used for statistical analysis, with p < 0.05 as the cutoff for significance. Comparisons were controlled for co-infection, parity, congenital abnormality, and maternal race and ethnicity, age, education attainment, cigarette use, and weight. RESULTS: A total of 31,200 pregnancies analyzed were complicated by maternal HCV. Infection was significantly positively associated with gestational hypertension (adj. OR: 1.09), Cesarean section (1.27), and maternal ICU stay (2.61). Many adverse neonatal outcomes were also increased with HCV infection, including overall preterm delivery (1.76), NICU stay (2.67), congenital abnormality (1.59), and neonatal seizure (3.72). Infection was negatively associated with gestational diabetes (0.77), chorioamnionitis (0.82), and macrosomia (0.79). CONCLUSION: HCV infection is independently associated with increased odds of many neonatal complications and several maternal complications. However, it also appears to be protective against a minority of adverse outcomes. Further investigation is required to determine if these differences are attributable to non-controlled socioeconomic factors, increased monitoring throughout pregnancy, or pathophysiologic mechanisms of infection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.