What Donald Trump would do with the US healthcare system

Page, Leigh

doi:10.1136/bmj.i2996

Cited by 8 publications

(7 citation statements)

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“…Indeed, medical error causes the patient harm because of two factors; individual or systemic 48. There is a risk of human error behind every endeavor, but each person should be held accountable only for things under his control.…”

Section: Root Analysis: From “Culture Of Blame” To a “Just Culture”mentioning

confidence: 99%

Second victims in health care: current perspectives

Özeke¹,

Özeke

Çoşkun

et al. 2019

AMEP

111

109

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Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient’s quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then ﬁnd themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.

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Section: Root Analysis: From “Culture Of Blame” To a “Just Culture”mentioning

confidence: 99%

Second victims in health care: current perspectives

Özeke¹,

Özeke

Çoşkun

et al. 2019

AMEP

111

109

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“…Sepsis is one of the leading causes of death worldwide 1. Early recognition of patients with poor prognosis is important for clinicians to prescribe personalized therapies, including timely fluid, resuscitation therapy,2–4 and appropriate antimicrobial therapy 5.…”

Section: Introductionmentioning

confidence: 99%

Presepsin level in predicting patients’ in-hospital mortality from sepsis under sepsis-3 criteria

Wen

Huang

Yang

et al. 2019

TCRM

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Background: Early recognition of septic patients with poor prognosis is important for clinicians to prescribe personalized therapies which include timely fluid resuscitation therapy and appropriate antimicrobial therapy. We aimed to evaluate the effect of the presepsin level on predicting the prognosis of patients with sepsis under the sepsis-3 criteria. Methods: Patients who were diagnosed as sepsis under the sepsis-3 criteria were recruited and assigned to the survivor group and the non-survivor group according to their in-hospital mortality. The two groups' baseline characteristics were analyzed with Pearson's chi-square (χ 2) test or Kruskal-Wallis test. Binary logistic regression analysis was performed to determine the independent predictors of in-hospital mortality from sepsis. Receiver operating characteristic analysis was conducted to evaluate the efficacy of presepsin in predicting patients' in-hospital mortality from sepsis. The correlation between presepsin and the Sequential Organ Failure Assessment (SOFA) score was measured with Spearman's rank correlation coefficient. P-values of less than 0.05 were considered to indicate statistical significance. Results: Overall, 138 patients were included in this study. The presepsin level of the non-survivor group was significantly higher than that of the other group (P=0.000). Binary logistic regression showed that the presepsin level was an independent risk factor of patients' in-hospital mortality from sepsis (OR =1.221 P=0.026). The presepsin level was positively associated with the SOFA score (ρ=0.396, P=0.000). ROC curve analysis revealed the presepsin level was highly accurate in predicting patients' in-hospital mortality from sepsis (AUC =0.703, P=0.000). The AUC value of a combination of presepsin and the SOFA score was significantly larger than that of the SOFA score alone (AUC: 0.817 vs 0.793, P=0.041). Conclusions: Presepsin is a prognostic biomarker with high accuracy in predicting the prognosis of sepsis under the sepsis-3 criteria.

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“…Medical errors are felt to be the third leading cause of death in the US. 26 Since diagnostic error can be caused by faulty clinical reasoning, SimWars could help save lives by allowing physicians to adopt the right path for patient evaluation and diagnosis. This is particularly important for training residents in the Emergency Department where most of the diagnostic evaluation occurs.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Simulation Wars on EM Residents’ Global Rating Scales and In-Training Examination Scores

Mendez¹,

Takenaka²,

Cardenas‐Turanzas³

et al. 2020

OAEM

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Purpose: The Accreditation Council for Graduate Medical Education (ACGME) restricted the duty hours for residents training in 2004. With less time to learn medicine, residents may not develop the clinical reasoning skills needed. Simulation can provide a remedy for this lack of time by allowing residents to practice skills and develop clinical reasoning in a simulated environment. Simulation Wars (SimWars), a clinical reasoning simulation has been shown to improve clinical reasoning skills. The purpose of the study was to investigate the effect of Simulation Wars on In-Training Examination (ITE) Scores and Global Rating Scale (GRS) Scores in Emergency Medicine (EM) residents. Methods: The Quasi-Experimental design was used in this retrospective study. The main comparison was between historical controls, the residents who did not participate in the Simulation Wars, and the intervention group comprised of residents who participated in the SimWars. Results: A total of 127 residents were participants in this study including 70 from the intervention and 57 from the historical control group. There were no significant differences found in GRS scores between both groups except for Communication and Professionalism (p<0.001). No overall improvement in ITE scores for the control group and for the intervention group was found. Furthermore, within the intervention group, while comparing those residents who participated in certain subcategories of SimWars and those who did not, there was a significant improvement in ITE scores in the subcategories of Thoracic Disorders, Abdominal/Gastrointestinal, Trauma Disorders and OBGyn. Conclusion: SimWars in the subcategories of Abdominal/Gastrointestinal, Thoracic, OBGyn and Trauma were found to be associated with improved ITE scores in those subcategories. Since Emergency Medicine utilizes extensive clinical reasoning skills, SimWars may provide better educational opportunities for EM residents.

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What Donald Trump would do with the US healthcare system

Abstract: Donald Trump’s pronouncements on health have often been unclear. Leigh Page assesses his policies

Cited by 8 publications

References 0 publications

<p>Second victims in health care: current perspectives</p>

<p>Second victims in health care: current perspectives</p>

<p>Presepsin level in predicting patients’ in-hospital mortality from sepsis under sepsis-3 criteria</p>

<p>The Effect of Simulation Wars on EM Residents’ Global Rating Scales and In-Training Examination Scores</p>

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