Blame and Medical Errors: Allocation of Blame for Medical Errors Among Physicians, Nurses and Administrators at an Academic Medical Center

Despite significant efforts among health care leaders in the past two decades to move away from the so-called culture of blame, individual blame for medical errors is still a significant presence in health care settings. Furthermore, little is understood about how individual people assign blame, and what differences, if any, exist between different health care professionals in how they assign individual blame. The study tested three hypotheses regarding the allocation of blame for medical errors. Hypothesis #1: Despite a shift towards systems-based thinking, health care professionals will blame individuals rather than the system for medical errors. Hypothesis #2: Even when given the exact same information, health care professionals will allocate blame or accountability for medical errors differently depending on their role in the health care system. Hypothesis #3: In general, health care professionals will allocate blame disproportionately towards other professions rather than blame their own professions. We conducted a detailed survey centered on a set of three standardized cases, each involving fictitious clinical vignettes during a single patient admission. Each case involved multiple medical errors, each of which was necessary but insufficient in isolation to result in the adverse outcome. After each case respondents allocated blame for the medical errors among four root causes that corresponded to nurses, physicians, and hospital administrators. A self blame ratio was calculated which examined the extent to which people disproportionately assigned blame to their own profession compared to the level of blame assigned them by other respondents. Overall, when given specific cases, respondents placed more blame on individuals than on systemic factors. Respondents placed more blame on physicians than on nurses, and hospital administrators placed more blame on the system and culture (non-individual factors) than either physicians or nurses placed on these factors. Respondents role within the health care system was of significant predictive value in determining how they would assign blame for standardized cases. ANOVA of the mean values of blame allocation across all three cases demonstrated statistically significant differences by respondents position for blame allocation to nurses (p =.004) and blame allocation to hospital system (p =.017) but not for blame allocation to physicians or blame allocated to hospital culture (p =.256 and p =.333, respectively). Self-blame scores averaged above 1.00 (1.20±.50, N=85), indicating that respondents in general placed more blame on their own professions than others placed on them. This held true across all three groups, but was the most pronounced with nurses (1.40±.48, N=24), moderately pronounced with administrators (1.09±.34, N=38), and the least pronounced with physicians (1.17±.67, N=23). ANOVA of differences between groups was statistically significant (p =.049). Conclusions: Respondents placed more blame on individuals than non-individuals; role within the hospital was a significant predictor of blame allocation; and respondents overall tended to blame their own professions more than others blamed them

Cost Saving or Cost Effective? Unanswered Questions in the Screening of Patients With Nonalcoholic Fatty Liver Disease

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151870/1/hep41386_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151870/2/hep41386.pd

Pattern formation during de novo assembly of the Arabidopsis shoot meristem

Most multicellular organisms have a capacity to regenerate tissue after wounding. Few, however, have the ability to regenerate an entire new body from adult tissue. Induction of new shoot meristems from cultured root explants is a widely used, but poorly understood, process in which apical plant tissues are regenerated from adult somatic tissue through the de novo formation of shoot meristems. We characterize early patterning during de novo development of the Arabidopsis shoot meristem using fluorescent reporters of known gene and protein activities required for shoot meristem development and maintenance. We find that a small number of progenitor cells initiate development of new shoot meristems through stereotypical stages of reporter expression and activity of CUP-SHAPED COTYLEDON 2 (CUC2), WUSCHEL (WUS), PIN-FORMED 1 (PIN1), SHOOT-MERISTEMLESS (STM), FILAMENTOUS FLOWER (FIL, also known as AFO), REVOLUTA (REV), ARABIDOPSIS THALIANA MERISTEM L1 LAYER (ATML1) and CLAVATA 3 (CLV3). Furthermore, we demonstrate a functional requirement for WUS activity during de novo shoot meristem initiation. We propose that de novo shoot meristem induction is an easily accessible system for the study of patterning and self-organization in the well-studied model organism Arabidopsis

Low LDL-C and High HDL-C Levels Are Associated with Elevated Serum Transaminases amongst Adults in the United States: A Cross-sectional Study

Background: Dyslipidemia, typically recognized as high serum triglyceride, high low-density lipoprotein cholesterol (LDL-C) or low high-density lipoprotein cholesterol (HDL-C) levels, are associated with nonalcoholic fatty liver disease (NAFLD). However, low LDL-C levels could result from defects in lipoprotein metabolism or impaired liver synthetic function, and may serve as ab initio markers for unrecognized liver diseases. Whether such relationships exist in the general population has not been investigated. We hypothesized that despite common conception that low LDL-C is desirable, it might be associated with elevated liver enzymes due to metabolic liver diseases. Methods and Findings: We examined the associations between alanine aminotransferase (ALT), aspartate aminotransferase (AST) and major components of serum lipid profiles in a nationally representative sample of 23,073 individuals, who had no chronic viral hepatitis and were not taking lipid-lowering medications, from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. ALT and AST exhibited non-linear U-shaped associations with LDL-C and HDL-C, but not with triglyceride. After adjusting for potential confounders, individuals with LDL-C less than 40 and 41–70 mg/dL were associated with 4.2 (95% CI 1.5–11.7, p = 0.007) and 1.6 (95% CI 1.1–2.5, p = 0.03) times higher odds of abnormal liver enzymes respectively, when compared with those with LDL-C values 71–100 mg/dL (reference group). Surprisingly, those with HDL-C levels above 100 mg/dL was associated with 3.2 (95% CI 2.1–5.0, p<0.001) times higher odds of abnormal liver enzymes, compared with HDL-C values of 61–80 mg/dL. Conclusions: Both low LDL-C and high HDL-C, often viewed as desirable, were associated with significantly higher odds of elevated transaminases in the general U.S. adult population. Our findings underscore an underestimated biological link between lipoprotein metabolism and liver diseases, and raise a potential need for liver evaluation among over 10 million people with particularly low LDL-C or high HDL-C in the United States