PubMed · 15079949
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Mary Alice Gaston. 2004. Responding to diversity.. https://pubmed.ncbi.nlm.nih.gov/15079949/
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BACKGROUND: The goal of this project was to develop an interview to evaluate psychiatrists' views on the nature of cognitive dysfunction in schizophrenia, its importance as a potential treatment target, and its relative importance as a treatment target across different phases of schizophrenia. MATERIALS AND METHODS: A survey (available in paper or on-line) consisting of 27 questions, was developed by the Focus on Cognition in Schizophrenia (FOCIS) group, and distributed in a single wave mailing to 63,295 psychiatrists in 21 countries worldwide. RESULTS: The overall response rate was 4.7% (n=2975). The surveyed psychiatrists perceived cognition as a high treatment priority in stabilized schizophrenia patients, but less so for first episode or acute schizophrenia patients. The potential of atypical antipsychotics to improve cognitive dysfunction in schizophrenia was identified by 81% of the respondent psychiatrists. CONCLUSIONS: Cognitive deficits in people with schizophrenia are seen by clinical psychiatrists as relevant to treatment and rehabilitation plans. They were, however, regarded as a higher treatment priority in stabilized chronic rather than in first episode patients. The results suggest clinical psychiatrists need additional education regarding the nature of cognitive dysfunction in schizophrenia and its importance for psychosocial rehabilitation and community re-entry.
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CONTEXT: The Institute of Medicine has recommended establishing mandatory error reporting systems for hospitals and other health settings. OBJECTIVE: To examine the opinions and experiences of hospital leaders with state reporting systems. DESIGN AND SETTING: Survey of chief executive and chief operating officers (CEOs/COOs) from randomly selected hospitals in 2 states with mandatory reporting and public disclosure, 2 states with mandatory reporting without public disclosure, and 2 states without mandatory systems in 2002-2003. MAIN OUTCOME MEASURES: Perceptions of the effects of mandatory systems on error reporting, likelihood of lawsuits, and overall patient safety; attitudes regarding release of incident reports to the public; and likelihood of reporting incidents to the state or to the affected patient based on hypothetical clinical vignettes that varied the type and severity of patient injury. RESULTS: Responses were received from 203 of 320 hospitals (response rate = 63%). Most CEOs/COOs thought that a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital's own internal reporting system (69%) and encourage lawsuits (79%) while having no effect or a negative effect on patient safety (73%). More than 80% felt that the names of both the hospital and the involved professionals should be kept confidential, although respondents from states with mandatory public disclosure systems were more willing than respondents from the other states to release the hospital name (22% vs 4%-6%, P = .005). Based on the vignettes, more than 90% of hospital leaders said their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even when the incident was of sufficient consequence that they would tell the affected patient or family. CONCLUSIONS: Most hospital leaders expressed substantial concerns about the impact of mandatory, nonconfidential reporting systems on hospital internal reporting, lawsuits, and overall patient safety. While hospital leaders generally favor disclosure of patient safety incidents to involved patients, fewer would disclose incidents involving moderate or minor injury to state reporting systems.