Objective: To determine how commonly articles are retracted on the basis of unintentional mistakes, and whether these articles differ from those retracted for scientific misconduct in authorship, funding, type of study, publication, and time to retraction. Data source and study selection: All retractions of English language publications indexed in MEDLINE between 1982 and 2002 were extracted. Data extraction: Two reviewers categorised the reasons for retraction of each article as misconduct (falsification, fabrication, or plagiarism) or unintentional error (mistakes in sampling, procedures, or data analysis; failure to reproduce findings; accidental omission of information about methods or data analysis). Data synthesis: Of the 395 articles retracted between 1982 and 2002, 107 (27.1%) were retracted because of scientific misconduct, 244 (61.8%) because of unintentional errors, and 44 (11.1%) could not be categorised. Compared with articles retracted because of misconduct, articles with unintentional mistakes were more likely to have multiple authors, no reported funding source, and to be published in frequently cited journals. They were more likely to be retracted by the author(s) of the article, and the retraction was more likely to occur more promptly (mean, 2.0 years; 95% CI, 1.8–2.2) than articles withdrawn because of misconduct (mean, 3.3 years; 95% CI, 2.7–3.9) (P < 0.05 for all comparisons). Conclusions: Retractions in the biomedical literature were more than twice as likely to result from unintentional mistakes than from scientific misconduct. The different characteristics of articles retracted for misconduct and for mistakes reflect distinct causes and, potentially, distinct solutions.

The goals of this exploratory study were (a) to describe, among African-American PACE (Program of All-Inclusive Care for the Elderly) enrollees, verbalized preferences for end-of-life care as compared to preferences for care as documented in their medical record and (b) to explore the personal values that inform end-of-life decision making among these frail elders. Medical record review and semi-structured interviews generated descriptive and qualitative data for 18 African-American enrollees in a PACE program located in a large eastern city of the United States. Review of verbalized and documented preferences for end-of-life care among participants indicated that most preferred life-sustaining treatments. In addition, findings suggest that these PACE enrollees had limited information or understanding of the interventions and terminology associated with advance directives. Content analysis of interviews indicated that end-of-life decision making was influenced by the desire to maintain usual activities of daily living; to avoid burdening caregivers; and to remain in control of personal health care. Furthermore, these African-American elders relied on faith in God as central to medical decision making, believing ultimately that God controls the end of life. This research may enhance the ability of social workers, in collaboration with other members of PACE or similar interdisciplinary teams, to understand the values and attitudes associated with the preferences of older African Americans for care at the end of life. These findings suggest future research is needed to ensure advance care planning acknowledges and responds to the values and preferences of African-American PACE enrollees for the end of life.

Medical errors in the general medical sector result in significant patient deaths and injuries, as well as high costs to the health care system. Despite the growing literature on errors in medical and surgical specialties, few studies have examined the incidence, nature, predictors, and prevention of errors that may occur in mental health treatment settings. The purpose of the current review is to examine the lessons learned from patient-safety research in the general medical sector, provide examples of types of errors in psychiatry, review the errors identified in the literature, offer a discussion of error-reduction strategies for improving patient safety, and provide recommendations for future research. Increased attention to medical errors in psychiatry is necessary in order to build safer health systems and promote a culture of safety among providers, thereby producing better care for patients with mental disorders.

This study examined the patterns and correlates of group and organizational involvement among persons with psychiatric disabilities using a cross-sectional, probability sample of 252 residents in supported independent housing (SIH). Groups and organizations were classified according to whether or not they have a behavioral health focus. Demographic, clinical, and service use characteristics were examined as potential predictors of membership using Poisson regression models. Findings indicated that 60% of the sample was involved in some kind of behavioral or nonbehavioral health organization. Similar to the findings from the general population, higher rates of membership were found among older persons, Blacks, those with more years of education, and those with higher incomes. Other correlates specific to the SIH sample included prior homelessness, perceived discrimination, substance abuse history, psychiatric symptoms, psychiatric diagnosis, and contact with service providers. Implications of study findings for developing intervention strategies to enhance organizational membership and for future research are discussed.

While prior research has identified the impact, nature, and causes of medical error in general medical settings, little is known about errors in inpatient psychiatry. Understanding the broad range of errors that occur in inpatient psychiatry is a critical step toward improving systems of care for a vulnerable patient population. An explorative qualitative analysis of key informant interviews identified a preliminary typology of errors and the contextual factors that precipitate them in inpatient psychiatry. The types of errors and their contextual factors fall broadly within the rubric of categories identified in medicine and surgery. However, many of the specific errors and contextual factors manifest themselves differently and are shaped by the uniqueness of the inpatient psychiatric setting and patient population. Interventions geared toward improving systems of care for psychiatric patients should draw on best practices for safety in medicine and surgery, but also be complemented with new strategies specifically tailored to the inpatient psychiatric setting.