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The article offers information on gaps in patient safety, highlighting areas that require attention. Topics discussed include the need for improved patient safety in clinics, small hospitals, long-term care facilities, and home care, with a specific emphasis on the challenges faced by vulnerable populations.

The article informs about the author's journey into patient safety research, sparked by personal experiences and the lack of literature on medical errors during their fellowship. Topic include It explores the motivations of other leaders in patient safety, including personal experiences, compelling questions, job opportunities, and organizational initiatives, highlighting diverse paths into the field.

An editorial is presented on enhancing patient safety by engaging patients and families, emphasizing the significance of their involvement in healthcare safety efforts, particularly in the context of World Patient Safety Day 2023. Topics discussed include the role of patients in shaping healthcare policies and plans, learning from patient experiences to improve safety, and the importance of transparency and openness in healthcare, including incident disclosure to patients and families.

The article focuses on the persistent issue of medication errors in healthcare despite interventions, with a specific focus on the World Health Organization's (WHO) "Medication Without Harm" campaign aiming to reduce medication-related harm. It discusses the campaign's "5 Moments for Medication Safety" tool, emphasizing the need for more extensive adoption and systematic evaluation.

Over the past 2 decades, patient safety has become an established priority in human healthcare. There is a large body of research in human medicine on harm caused by healthcare, its impact, and interventions to prevent it. There are also numerous guidelines, policies, and regulations to improve safety. An important realization has been that the same errors that harm patients can also harm members of the healthcare team. Empathetic handling of safety incidents can have positive effects on both the wellbeing of providers and their care of patients. An essential element in patient safety is the creation of a "culture of safety" within the health care team. A strong culture of safety describes a work environment where risk is acknowledged, individuals can report errors without fear of punishment, and the organization has a commitment to collaboratively implementing system changes to prevent future errors. A key element of safety culture is ensuring that healthcare team members are supported and asked to help create solutions for safer care. The principles of safety science and practices to improve safety have not yet been widely adopted in veterinary medicine. We describe a case of a serious medication error and how it was handled to illustrate key components of a culture of safety and a system‐based approach to improvement. This case is timely as a recent review of patient safety events in 3 veterinary hospitals found medication‐related errors to be the most frequently reported events. Open conversations about safety events and errors that can harm not only our patients but also our healthcare teams will help veterinary professionals learn from their mistakes, support members of the team, and prevent future harm. [ABSTRACT FROM AUTHOR]

The article provides insights into the influence of social determinants of health (SDOH) on patient safety. It highlights various examples, such as low health literacy and inconsistent transportation, and emphasizes the need for healthcare organizations to address SDOH to improve safety and equity. The article suggests that integrating equity into existing quality and safety frameworks, collecting patient-level data on SDOH, and engaging with communities can help mitigate the impact of SDOH.

An introduction is presented which discusses the article on patient safety reports, underused technology like patient-reported outcome measures (PROs), and efforts to involve patients in improving healthcare safety, citing examples like the Patient Measure of Safety (PMOS).

An editorial is presented on the concept of creating a 'just culture' in healthcare to improve patient safety by shifting away from blame and punishment for medical errors. Topics include the need to recognize systemic errors and vulnerabilities, the challenge of finding the balance between blame and accountability; and the importance of training and understanding in implementing a just culture which prevails in healthcare.

Objective: Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions.Methods: Ninety-seven descriptions of "good" and "poor" care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care.Results: The physicians, nurses and patients raised the following "quality of care" aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building "quality cultures"; and organizational implementation of fluid system procedures.Conclusion: Respondents primarily referred to care processes in their descriptions of "quality of care." "Hippocratic pride" (in response to care successes) and "Rapid reactivity" (in response to (near) failures) emerged as two new outcome indicators of high-quality care.Practice Implications: This study provides a first qualitative fundament for understanding the components of "quality of care" from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks. [ABSTRACT FROM AUTHOR]

The article focuses on an important occasion for Action against Medical Accidents, the path-breaking charity for patient safety and justice. Topics include examines the timing is noteworthy in two respects first, it is their 40th anniversary as a charity and they may have been the first patient organization focused on patient safety and they have played a significant role in the birth and raising of the patient safety movement, both in the UK and worldwide.

The COVID-19 pandemic has placed extraordinary stresses on healthcare workers. Combined with disruptions to daily life outside of work, health care professionals experience a high prevalence of anxiety, depression, acute stress reaction, burnout, and PTSD. Top leaders at Johns Hopkins Medicine appreciated the mission-critical importance of maintaining the well-being and resilience of its essential workers. In March 2020 they asked the Johns Hopkins RISE (Resilience in Stressful Events) peer support program to help organize support for all staff. RISE made several adjustments, including adding virtual encounters to the usual in-person support, training additional peer responders, and rounding proactively on active units. Communication was broadened to reach less visible and lower wage workers. RISE collaborated actively with hospital epidemiology and infection control and began reporting regularly at incident command centre briefings. RISE also began to coordinate efforts with the other helping programs within the institution including the Office of Well-being, Employee Assistance, Spiritual Care, and Psychiatry. The number of calls and staff supported rose sharply. RISE supported over 4226 workers in the first 9 months of the pandemic. The adoption of RISE programs was accelerated at affiliated hospitals, as well as at other hospitals across the country in partnership with the Maryland Patient Safety Center. Experience with large scale disasters predicted correctly that worker distress would increase and persist beyond the initial wave of the pandemic. With subsequent surges of COVID-19, exhaustion and moral distress became nearly universal among workers. It is urgent for institutions to provide mechanisms to help their workers cope with the ongoing crisis and other crises that will inevitably occur in the future. [ABSTRACT FROM AUTHOR]

Introduction: Almost all patient-reported outcomes measures (PROMs) are text-based, which impedes accurate completion by low and limited literacy patients. Few PROMs are designed or validated to be self-administered, either in clinical or research settings, by patients of all literacy levels. We aimed to adapt the Patient Reported Outcomes Measurement Information System Upper Extremity Short Form (PROMIS-UE) to a multimedia version (mPROMIS-UE) that can be self-administered by hand and upper extremity patients of all literacy levels. Methods: Our study in which we applied the Multimedia Adaptation Protocol included seven phases completed in a serial, iterative fashion: planning with our community advisory board; direct observation; discovery interviews with patients, caregivers, and clinic staff; ideation; prototyping; member-checking interviews; and feedback. Direct observations were documented in memos that underwent rapid thematic analysis. Interviews were audio-recorded and documented using analytic memos; a rapid, framework-guided thematic analysis with both inductive and deductive themes was performed. Themes were distilled into design challenges to guide ideation and prototyping that involved our multidisciplinary research team. To assess completeness, credibility, and acceptability we completed additional interviews with member-checking of initial findings and consulted our community advisory board. Results: We conducted 12 hours of observations. We interviewed 17 adult English-speaking participants (12 patients, 3 caregivers, 2 staff) of mixed literacy. Our interviews revealed two distinct user personas and three distinct literacy personas; we developed the mPROMIS-UE with these personas in mind. Themes from interviews were distilled into four broad design challenges surrounding literacy, customizability, convenience, and shame. We identified features (audio, animations, icons, avatars, progress indicator, illustrated response scale) that addressed the design challenges. The last 6 interviews included member-checking; participants felt that the themes, design challenges, and corresponding features resonated with them. These features were synthesized into an mPROMIS-UE prototype that underwent rounds of iterative refinement, the last of which was guided by recommendations from our community advisory board. Discussion: We successfully adapted the PROMIS-UE to an mPROMIS-UE that addresses the challenges identified by a mixed literacy hand and upper extremity patient cohort. This demonstrates the feasibility of adapting PROMs to multimedia versions. Future research will include back adaptation, usability testing via qualitative evaluation, and psychometric validation of the mPROMIS-UE. A validated mPROMIS-UE will expand clinicians' and investigators' ability to capture patient-reported outcomes in mixed literacy populations. [ABSTRACT FROM AUTHOR]

An editorial is presented on patient safety being a priority for all health care organizations. Topics include program being fully online, part-time, and designed for working professionals where the majority of students never visiting the campus and never met other students in-person; and opportunities offered by academic institutions, government agencies, not-for-profits, member organizations, and private groups.

An editorial is presented on the mitigating the July effect. Topics include the arrival of a crop of newly graduated medical students beginning their internships, the influx of so many freshly trained physicians arriving at the same time always triggers concern, and the belief in a July effect with presumed adverse consequences for patient safety and quality of care.

A personal narrative is presented which explores the authors experience of having patient safety at the start of the career in research.

An editorial is presented on expression has practical and even literal meaning in our field of health care went to see a patient in a pediatric neuro-behavioral unit. Topics include Clinicians are at risk for these events, but so are other workers who interact with patients and feel invested in their care, including workers in nutrition, environmental services, security, and patient transport; and workaround is a method for overcoming a problem in a workflow or system.

An introduction is presented in which the editors discuss articles in the issue on topics including maintaining safety in a continuing care retirement community during the COVID-19 pandemic, evaluation of rapid severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) point-of-care testing in a nursing home setting, and importance of communication in securing timely, high-quality care.

The article discusses the COVID-19 crisis has placed an enormous strain on hospitals and health systems. Topics include the novelty of the disease led to uncertainty and chaos in health care systems; and the pandemic has created problems with patient safety and health care quality at multiple levels of the system.

An editorial is presented on the professional meetings and conferences dealing with patient safety and quality, and have consistently observed one key theme. The article discusses that the tone of the discussion is kinder and more respectful, and there is greater urgency to find solutions; and their presence exerts a gravitational pull, shifting the balance of discussion toward the patient perspective.

An editorial is presented as the supporting the emotional well-being of health care workers during the COVID-19 pandemic. Topics inlcude the COVID-19 pandemic is emerging as the defining health crisis of our generation, the health care organizations were already a high-risk environment for workers who has exposed on a daily basis to the suffering of the patients, and caring for patients with COVID-19 places them at personal risk for infection to threat the emotional well-being.

The article discusses Pragmatic Clinical Trials (PCTs) for Future Patients. Topics discussed include information on PCTs which is a randomized controlled trials designed to evaluate the effectiveness of interventions in individuals or groups; management of collateral findings discovered during the conduct of PCTs; and appropriate practices for return of results to research participants.

Introduction: This cluster RCT aimed to reduce healthcare utilization and increase the referral of patients between an academic health center and local community-based organizations (CBOs) that address social determinants of health.Study Design: Cluster RCT.Settings/participants: Twenty-two CBOs located in Baltimore, Maryland, were randomly assigned to the intervention or control group, and 5,255 patients were allocated to the intervention or control group based on whether they lived closer to an intervention or control CBO. Data were collected in 2014-2016; the analysis was conducted in 2016.Intervention: A multicomponent intervention included an online tool to help refer clients to community resources, meet-and-greet sessions between CBO staff and healthcare staff, and research assistants.Main Outcome Measures: The primary outcomes were patient emergency department visits and days spent in the hospital. Additional outcomes for CBO clients included knowledge of other CBOs, number of referrals to CBOs by the healthcare system, and number of referrals to healthcare system by CBOs. Outcomes for CBO staff included the number of referrals made to and received from the healthcare system and the number of referrals made to and received from other CBOs.Results: There was no significant effect of the intervention on healthcare utilization outcomes, CBO client outcomes, or CBO staff outcomes. Ancillary analyses demonstrated a 2.9% increase in referrals by inpatient staff to intervention CBOs (p=0.051) and a 6.6% increase in referrals by outpatient staff to intervention CBOs between baseline and follow-up (p=0.027). Outpatient staff reported a significant reduction in barriers related to the lack of information about CBO services (-18.3%, p=0.004) and an increase in confidence in community resources (+14.4%, p=0.023) from baseline to follow-up.Conclusions: The intervention did not improve healthcare utilization outcomes but was associated with increased healthcare staff knowledge of, and confidence in, local CBOs.Trial Registration: This study is registered at www.clinicaltrials.gov NCT02222909. [ABSTRACT FROM AUTHOR]

An editorial is presented on the lack of progress in reducing patient harm in healthcare despite the advancements in the field over the past three decades. Topics include the complexity of healthcare, new therapeutic modalities, the aging population, and the COVID-19 pandemic; and developing an organizational culture of safety in healthcare organizations to stay ahead of changes and improve patient safety.

An editorial is presented on the masks which are off–maintaining gains in patient safety post COVID-19. The article discusses that the destination was on the ocean, and the complex of small apartments featured swimming pools, beach games and an extremely well-attended donut shop; and mask-wearing requirements in our region had just been dropped, and the boys cavorted in the surf and luxuriated in their release from masking and social-distancing.

The management of high-utilizing patients is an area of active research with broad implications for the healthcare system. There are significant operational challenges to designing primary care models for these medically complex, high-needs patients. Although it is crucial to provide a high degree of continuity of care for this population, managing a cohort of these patients can lead to provider over-work and attrition. This may be magnified by the lack of training dedicated to addressing the unique care needs of these patients. While academic medical centers would seem well suited to care for individuals with multimorbidity needing intensive and specialized treatment, primary care providers in this setting need additional support to be clinically available for patients while pursuing scholarship and teaching. Formally recognizing intensive outpatient care as a specialty within internal medicine would help overcome some of these challenges. This would require a committed effort to high-level systems changes including a new focus on graduate medical education, the creation of division-level infrastructure within academic departments of medicine, and realistic levels of financial support to make this a viable career path. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses several reports within the issue on topics including usefulness of practice management guidelines during the Covid-19 pandemic; improving patient safety; and optimizing technology to reduce preventable adverse events.

An editorial is presented on a fundamental problem at the heart of health care. Topics include person approach focusing on the errors and violations of individuals and aiming remedial efforts at front line workers; and discouraging the reporting of safety incidents showing frustrating efforts to learn from mistake.

An editorial is presented on Patient safety suggestions. Topics include "Teaming up" which feature importance of communication over knowledge; "Thinking smarter" include cognitive tasks such as collaboration and examination; and "Communicating with patients" include proper mindful communication with patients.

An editorial is presented on the World Patient Safety Day on 2019. Topics include the World Health Assembly had adopted a resolution which urged Member States to pay the closest possible attention to the problem of patient safety, recognizing patient safety as a global health priority, and marking a major milestone in the worldwide movement for patient safety.

The article presents the author's views on the bimonthly periodical "Clinical Risk as the Journal of Patient Safety and Risk Management." Various topics discussed include its focus on publishing articles related to patient safety, study on causes of mortality and morbidity, medical care among low- and middle-income countries.

An introduction is presented in which the editor discusses articles in the issue on topics including the utility of strategically placed just-in time reminders to cue clinicians, the effectiveness of mindfulness-based interventions, and strategy based on error management theory.

The article presents information on the 4th Global Ministerial Patient Safety Summit 2019, Jeddah. Topics discussed include evidence base for effective patient safety practices, the need to improve care delivery systems and patient outcomes worldwide, and effective strategies to perform hand hygiene can be frustrated by the lack of running water or supply of alcohol for hand rub.

An editorial is presented on patient getting injured by medical error which gives one feeling of anger, guilt and numbness and mentions that such error can lead physicians to suffer from anxiety and post-traumatic stress disorder (PTSD). Topics discussed include efforts of hospitals on enhancing patient experience, medical care and reducing costs, World Health Organization (WHO's) core action principles of Psychological first aid (PFA) and use of cardiopulmonary resuscitation (CPR).

Background: The goal of antiretroviral therapy (ART) is to suppress viral replication, reduce morbidity and mortality, and improve quality of life (QoL). For resource-limited settings, the World Health Organization recommends a first-line regimen of two-nucleoside reverse-transcriptase inhibitors and one non-nucleoside transcriptase inhibitor (nevirapine (NVP) or efavirenz (EFV)). There are few data comparing the QoL impact of NVP versus EFV. This study assessed the change in QoL and factors associated with QoL among HIV patients receiving ART regimens based on EFV or NVP. Methods: We enrolled 640 people with HIV eligible for ART who received regimens including either NVP or EFV. QoL was assessed at baseline, three months and six months using Physical Health Summary (PHS) and Mental Health Summary (MHS) scores and the Global Person Generated Index (GPGI). Data were analyzed using generalized estimating equations, with ART regimen as the primary exposure, to identify associations between patient and disease factors and QoL. Results: QoL increased on ART. The mean QoL scores did not differ significantly for regimens based on NVP versus EFV during follow-up for MHS and GPGI regardless of CD4 stratum and for PHS among patients with a CD4 count >250 cells/μL. The PHS-adjusted β coefficients for ART regimens based on EFV versus NVP by CD4 count strata were as follows: -1.61 (95 % CI -2.74, -0.49) for CD4 count <100 cells/μL; 0.82 (0.22, 1.43) for CD4 count 101-250 cells/μL; and -1.33 (-5.66, 3.00) for CD4 count >250 cells/μL. The corresponding MHS-adjusted β coefficients were as follows: -0.39 (-1.40, 0.62) for CD4 < 100 cells/μL; 0.16 (-0.66, 0.98) for CD4 count 101-250 cells/μL; and -0.75 (-2.01, 0.51) for CD4 count >250 cells/μL. The GPGI-adjusted odds ratios for EFV versus NVP were 0.51 (0.25, 1.04) for CD4 count <100 cells/μL, 0.98 (0.60, 1.58) for CD4 count 101-250 cells/μL, 1.39 (0.66, 2.90) for CD4 > 250 cells/μL. QoL improved among patients on EFV over the 6-month follow-up period (MHS p < 0.001; PHS p = 0.04, p = 0.028). Overall, patients with depression (PHS p < 0.001; GPGI p < 0.001) had lower scores and women had lower MHS (on NVP, p = 0.001). Other factors associated with lower QoL included alcohol use, low education level and advanced HIV disease. Conclusions: ART improves QoL. The results support use of either NVP or EFV. Patients initiating ART should be assessed for depression and managed appropriately. Women may require extra support to improve their QoL. [ABSTRACT FROM AUTHOR]

Background: The goal of antiretroviral therapy (ART) is to suppress viral replication, reduce morbidity and mortality, and improve quality of life (QoL). For resource-limited settings, the World Health Organization recommends a first-line regimen of two-nucleoside reverse-transcriptase inhibitors and one non-nucleoside transcriptase inhibitor (nevirapine (NVP) or efavirenz (EFV)). There are few data comparing the QoL impact of NVP versus EFV. This study assessed the change in QoL and factors associated with QoL among HIV patients receiving ART regimens based on EFV or NVP. Methods: We enrolled 640 people with HIV eligible for ART who received regimens including either NVP or EFV. QoL was assessed at baseline, three months and six months using Physical Health Summary (PHS) and Mental Health Summary (MHS) scores and the Global Person Generated Index (GPGI). Data were analyzed using generalized estimating equations, with ART regimen as the primary exposure, to identify associations between patient and disease factors and QoL. Results: QoL increased on ART. The mean QoL scores did not differ significantly for regimens based on NVP versus EFV during follow-up for MHS and GPGI regardless of CD4 stratum and for PHS among patients with a CD4 count >250 cells/μL. The PHS-adjusted β coefficients for ART regimens based on EFV versus NVP by CD4 count strata were as follows: −1.61 (95 % CI −2.74, −0.49) for CD4 count <100 cells/μL; 0.82 (0.22, 1.43) for CD4 count 101–250 cells/μL; and −1.33 (−5.66, 3.00) for CD4 count >250 cells/μL. The corresponding MHS-adjusted β coefficients were as follows: −0.39 (−1.40, 0.62) for CD4 < 100 cells/μL; 0.16 (−0.66, 0.98) for CD4 count 101–250 cells/μL; and −0.75 (−2.01, 0.51) for CD4 count >250 cells/μL. The GPGI-adjusted odds ratios for EFV versus NVP were 0.51 (0.25, 1.04) for CD4 count <100 cells/μL, 0.98 (0.60, 1.58) for CD4 count 101–250 cells/μL, 1.39 (0.66, 2.90) for CD4 > 250 cells/μL. QoL improved among patients on EFV over the 6-month follow-up period (MHS p < 0.001; PHS p = 0.04, p = 0.028). Overall, patients with depression (PHS p < 0.001; GPGI p < 0.001) had lower scores and women had lower MHS (on NVP, p = 0.001). Other factors associated with lower QoL included alcohol use, low education level and advanced HIV disease. Conclusions: ART improves QoL. The results support use of either NVP or EFV. Patients initiating ART should be assessed for depression and managed appropriately. Women may require extra support to improve their QoL. [ABSTRACT FROM AUTHOR]

An editorial is presented on the time to make childbirth safer. Topics include the maternal mortality rate in Switzerland was the lowest among the 37 Organisation for Economic Cooperation and Development (OECD) member countries, and the use of the Checklist did not reduce stillbirths, newborn or maternal mortality in a large multicentered trial in north India.

An editorial is presented to the article a consequence of COVID-19 hospital and others around the globe discovered more "essential workers" in their ranks. Topics include laundry workers keep medical facilities running by washing soiled linens, gowns and uniforms; and healthcare, for the COVID-19 pandemic the US Centers for Disease Control defines frontline essential workers.

Background The 2011 US Accreditation Council for Graduate Medical Education (ACGME) mandates reaffirm the need to design residency schedules to augment patient safety and minimise resident fatigue. Objectives To evaluate which elements of the residency schedule were associated with resident burnout and fatigue and whether resident burnout and fatigue were associated with lower perceived quality of patient care. Methods A cross-sectional survey of first-year medicine residents at three hospitals in May-June 2011 assessed residency schedule characteristics, including hours worked, adherence to 2003 work-hour regulations, burnout and fatigue, trainee-reported quality of care and medical errors. Results Response rate was 55/76 (72%). Forty-two of the 55 respondents (76%) met criteria for burnout and 28/55 (51%) for fatigue. After adjustment for age, gender and residency programme, an overnight call was associated with higher burnout and fatigue scores. Adherence to the 80 h working week, number of days off and leaving on time were not associated with burnout or fatigue. Residents with high burnout scores were more likely to report making errors due to excessive workload and fewer reported that the quality of care provided was satisfactory. Conclusions Burnout and fatigue were prevalent among residents in this study and associated with undesirable personal and perceived patient-care outcomes. Being on a rotation with at least 24 h of overnight call was associated with higher burnout and fatigue scores, but adherence to the 2003 ACGME work-hour requirements, including the 80 h working week, leaving on time at the end of shifts and number of days off in the previous month, was not. Residency schedule redesign should include efforts to reduce characteristics that are associated with burnout and fatigue. [ABSTRACT FROM AUTHOR]

There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. [ABSTRACT FROM AUTHOR]

An editorial is presented on the US Air Force, a "red ball" is a maintenance issue that comes up before aircraft launch or during flight. It expresses the view that the issue is not resolved quickly and properly, the mission could suffer as the aircraft might crash or not be able to fly; and the term may date back further to the early 1900s, to a system used to indicate priority handling on the Santa Fe Railroad.

Background: Communication between caregivers and clinical team members is critical for transitional care, but its quality and potential impact on outcomes are not well understood. This study reports on caregiver‐reported quality of communication with clinical team members in the postpancreatectomy period and examines associations of these reports with patient and caregiver outcomes. Methods: Caregivers of patients with pancreatic and periampullary malignancies who had undergone pancreatectomy were surveyed. Instrument measures assessed care experiences using the Caregiver Perceptions About Communication with Clinical Team Members (CAPACITY) instrument. The instrument has two main subscales: communication, assessing the extent to which providers helped caregivers comprehend details of clinical visits, and capacity, defined as the extent to which providers assessed whether caregivers were able to care for patients. Results: Of 265 caregivers who were approached, 240 (90.6%) enrolled in the study. The mean communication and capacity subscale scores were 2.7 ± 0.6 and 1.5 ± 0.6, respectively (range, 0–4 [higher = better]). Communication subscale scores were lower among caregivers of patients who experienced (vs. those who did not experience) a 30‐day readmission (2.6 ± 0.5 vs. 2.8 ± 0.6, respectively; p =.047). Capacity subscale scores were inversely associated with restriction in patient daily activities (a 0.04 decrement in the capacity score for every 1 point in daily activity restriction; p =.008). Conclusions: After pancreatectomy, patients with pancreatic and periampullary cancer whose caregivers reported worse communication with care providers were more likely to experience readmission. Caregivers of patients with greater daily activity restrictions were less likely to report being asked about the caregiver's skill and capacity by clinicians. Plain Language Summary: This prospective study used a validated survey instrument and reports on the quality of communication between health care providers and caregivers as reported by caregivers of patients with pancreatic and periampullary cancer after pancreatectomy.In an analysis of 240 caregivers enrolled in the study, lower communication scores (the extent to which providers helped caregivers understand clinical details) were associated with higher odds of 30‐day patient readmission to the hospital.In addition, lower capacity scores (the extent to which providers assessed caregivers' ability to care for patients) were associated with greater impairment in caregivers.The strikingly low communication quality and capacity assessment scores suggest substantial room for improvement, with the potential to improve both caregiver and patient outcomes. After pancreatectomy, patients with pancreatic and periampullary cancer whose caregivers reported worse communication with care providers were more likely to experience readmission. Caregivers of patients with greater daily activity restrictions were less likely to report being asked about the caregiver's skill and capacity by clinicians. [ABSTRACT FROM AUTHOR]

Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers. [ABSTRACT FROM AUTHOR]

Background: Selection of an appropriate patient-reported outcome (PRO) instrument for a clinical trial requires knowledge of the instrument's responsiveness to detecting treatment effects. The purpose of this study was to examine the responsiveness of two health-related quality of life (HRQL) instruments used in clinical trials involving HIV-infected adults: the HIV-targeted Medical Outcomes Study HIV Health Survey (MOS-HIV), and a generic measure, the EuroQol-5D (EQ-5D). Methods: A systematic review identified clinical trials using the MOS-HIV or EQ-5D to assess outcomes for HIVinfected adults. Data abstracted from each study included study type, treatment regimen(s), PRO results, and effect size (either reported or calculated). Effect size was calculated as the difference between baseline and follow-up mean scores divided by the baseline standard deviation. Magnitude was categorized as small (d=0.20), medium (d=0.50), and large (d=0.80). Results: Between 2005 and 2010, the MOS-HIV was administered in 12 trials. Significant differences were observed between groups and over time in physical health summary (PHS) and mental health summary (MHS) scores (P<0.05) in subjects switching therapy after experiencing Grade-2 adverse events. Effect sizes were medium (0.55 and 0.49 for PHS and MHS, respectively) among treatment-naïve adults beginning therapy (two studies), but negligible among treatment-experienced adults (0.04 and 0.13 for PHS and MHS, respectively; three studies). The EQ-5D was used in five trials between 2001 and 2010. It was responsive to occurrences of adverse events and opportunistic infections, with small-to-medium effect sizes (range 0.30-0.50) in each of its five dimensions. Conclusions: A systematic review of PRO study results showed both the MOS-HIV and EQ-5D were responsive to changes between groups and/or over time in treatment-naïve HIV-infected patients. These instruments may be used either individually or together in clinical trials to measure changes in HRQL. [ABSTRACT FROM AUTHOR]

Comparative effectiveness research generates evidence that helps consumers, clinicians, purchasers, and policy makers make better decisions about health care. Capturing the patient's perspective is central to this research because it provides a complete picture of treatment impact. This can be done with standardized questionnaires that ask patients to report on their functioning, well-being, symptoms, and satisfaction with care. These data, however, are not collected routinely in either clinical research or practice. Strategies and incentives to link patient-reported outcomes to data from conventional sources--including clinical research, electronic health records, and administrative data--will accelerate the development of useful evidence. [ABSTRACT FROM AUTHOR]

We thank Dr. Sandhu and colleagues for their insightful comments on our perspective article and sharing their viewpoint that skilled clinicians alone cannot address the needs of complex adult patients. Resident physicians routinely serve as the primary care providers for medically complex adult patients with high emergency room and inpatient utilization. [Extracted from the article]

Background: Racial differences in asthma care are not fully explained by socioeconomic status, care access, and insurance status. Appropriate care requires accurate physician estimates of severity. It is unknown if accuracy of physician estimates differs between black and white patients, and how this relates to asthma care disparities.Objective: We hypothesized that: 1) physician underestimation of asthma severity is more frequent among black patients; 2) among black patients, physician underestimation of severity is associated with poorer quality asthma care.Design, Setting and Patients: We conducted a cross-sectional survey among adult patients with asthma cared for in 15 managed care organizations in the United States. We collected physicians' estimates of their patients' asthma severity. Physicians' estimates of patients' asthma as being less severe than patient-reported symptoms were classified as underestimates of severity.Measurements: Frequency of underestimation, asthma care, and communication.Results: Three thousand four hundred and ninety-four patients participated (13% were black). Blacks were significantly more likely than white patients to have their asthma severity underestimated (OR = 1.39, 95% CI 1.08-1.79). Among black patients, underestimation was associated with less use of daily inhaled corticosteroids (13% vs 20%, p < .05), less physician instruction on management of asthma flare-ups (33% vs 41%, p < .0001), and lower ratings of asthma care (p = .01) and physician communication (p = .04).Conclusions: Biased estimates of asthma severity may contribute to racially disparate asthma care. Interventions to improve physicians' assessments of asthma severity and patient-physician communication may minimize racial disparities in asthma care. [ABSTRACT FROM AUTHOR]

Background: Ethical aspects of prevention trials, as they differ from therapeutic trials, have not been fully explored. This article aims to define and demonstrate the existence of “preventive misconception” (PM), a misunderstanding in which research participants in prevention trials make an “overestimate in probability or level of personal protection that is afforded by being enrolled in a trial of a preventive intervention.” Methods: A rating tool was developed to evaluate PM, using data collected between August 2000 and July 2002 as part of a nationwide study of the quality of informed consent in a trial of a shingles vaccine. During 2005–2006, two pair of raters assessed the responses of 50 participants to questions asked after the participants had given consent to participate in the shingles trial. Two pair of raters evaluated the response for the presence and type of PM. Each pair of raters adjudicated their responses and inter-rater reliability was assessed. Results: Adjudicated pairs of raters agreed that 32% (CI: 20.7%–45.9%) of participants showed evidence of PM (kappa=0.71, CI: 0.52–0.90); that 12% (CI: 5.2%–24.2%) of participants underestimated the probability of receiving placebo (kappa=0.53, CI: 0.24–0.83); and that 24% (CI: 14.2%–37.6%) overestimated the likely personal effectiveness of the experimental intervention (kappa=0.42, CI: 0.08–0.76). Conclusions: This study newly describes the concept of preventive misconception and empirically demonstrates its existence in trials of prevention. Study participants may overestimate the protection that they receive by being enrolled in a trial of prevention, which poses ethical challenges for research. [Copyright &y& Elsevier]

Caring for patients with COVID-19 is placing great stress on health care systems and health care workers. The authors summarize lessons learned from responding to other pandemics and offer best practices for facilitating organizational resilience and supporting health care workers during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]