Second victims in health care: current perspectives.

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

Is Hyperuricemia Overlooked when Treating Pediatric Tuberculosis Patients with Pyrazinamide?

The treatment of tuberculosis (TB) requires long-term multiple drug use. Hyperuricemia is frequently reported in adults, but there are few data for the pediatric population. This study aimed to review drug-related side effects in pediatric patients that received treatment for TB. Patients with active TB undergoing treatment were followed for drug-related side effects. During the 7 year period, 23 patients with a mean age of 7.9 +/- 4.66 years were treated. Drug-related side effects were observed in 14 patients. Hyperuricemia occurred in 12 of the 14 patients, vs. hepatotoxicity in 2. In all, eight of the patients with hyperuricemia had >= 2 episodes during pyrazinamide (PZA) therapy. Based on these findings, we devised an algorithm that could be used for the management of hyperuricemia in patients receiving PZA because of TB, and recommend that hyperuricemia be closely monitored during PZA therapy

Breaking bad news to patients with spinal cord injury in Turkey - physiatrists' perspective.

To explore Turkish physiatrists' experiences and opinions about breaking bad news (BBN) to patients with spinal cord injury (SCI)

Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey.

Prior abstract publication: 2nd Medical Rehabilitation Congress; Nov 4-7, 2010; Ankara, Turkey Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors

Attitudes and Knowledge for Smoking Among University Students

Objective: This study was planned to clarify the extent of the smoking epidemic among young persons in Turkey. Material and Methods: The study included 3156 students from a university in the capital of Turkey. The questionnaire was prepared according to the criteria of the World Health Organization (WHO). It included items for sociodemographic features and the smoking status of students and their families, and the smoking behavior of the students. Results: The final population consisted of 3156 students. While the overall frequency of current smokers was 30.6%, the frequencies of nonsmokers, ever-smokers, occasional smokers, and ex-smokers were 36.8%, 23.2%, 4.8%, and 4.6% respectively. Current tobacco use was significantly higher among male students (p<0.001). The percentage of smokers with a family member who smoked was 73.2%. The percentage of students that had tried to cease smoking in the previous year was 68.4%. Conclusion: University students comprise a large group of young Turkish people. Because one third of university students are regular smokers, serious interventions are required to prevent young persons from starting to smoke, rather than encouraging them to stop smoking after the behavior has already become a habit

Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey

Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors. Design: A cross sectional, qualitative study. Setting: Community. Participants: Fourteen spinal cord injury survivors. Interventions: Subjects participated in a semi-structured interview about `when', `where' by whom' and `how' they received and `would' prefer to receive bad news. Outcome measures: Answers to `how' questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary). Results: Eight participants (57\%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them. Conclusion: Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation