Teaching medical error apologies: development of a multi-component intervention.

BACKGROUND AND OBJECTIVES: Apologizing is an important component in addressing medical errors; yet, offering apologies continues to challenge physicians. To address limitations of prior educational interventions, a multi-faceted, apologies intervention was developed to provide medical students with increasingly applied learning opportunities. METHODS: First-year medical students taking a professionalism course at the authors' Southeastern medical school in 2008 or 2009 were eligible for the study. Data from their assigned activities and a post-intervention survey were analyzed. RESULTS: A total of 384 students contributed study data; 57.8% were male, 58.6% white, 10.9% Asian-Indian, 10.9% Asian-Other, and 7.6% African-American. Seventy-four percent of students considered tasks as useful or extremely useful. Student confidence in providing effective apologies increased as well as their comfort in disclosing errors to a faculty member or patient. Perceived importance of apology skills similarly increased. Apologies written by female authors were rated higher in effectiveness by peers than apologies written by male authors. Apology evaluators adopting patient perspective were more critical than evaluators adopting peer perspective. No race differences were found. CONCLUSIONS: This intervention was perceived useful by students and demonstrated medium to large effect size changes in importance, confidence, and comfort around apology errors. The higher evaluations of apologies written by female authors as well as the lower evaluations by evaluators adopting patient perspective warrant further consideration. Additional research is also warranted on streamlining and implementing the intervention for other institutions and ultimately how actual student apology behaviors are later affected.

Hyperinsulinemia and cognitive decline in a middle-aged cohort.

OBJECTIVE: Determining modifiable risks factors for cognitive decline and dementia are a public health priority as we seek to prevent dementia. Type 2 diabetes and related disorders such as hyperinsulinemia increase with aging and are increasing in the U.S. population. Our objective was to determine whether hyperinsulinemia is associated with cognitive decline among middle-aged adults without type 2 diabetes, dementia, or stroke in the Atherosclerosis Risk in Communities (ARIC) cohort. RESEARCH DESIGN AND METHODS: Middle-aged adults (aged 45-64 years at baseline) in the ARIC cohort had fasting insulin and glucose assessed between 1987 and 1989. Subjects with dementia, type 2 diabetes, or stroke at baseline were excluded from analysis. Three tests of cognitive function available at baseline and 6 years later were delayed word recall (DWR), digit symbol subtest (DSS), and first letter word fluency (WF). Cross-sectional comparisons and linear regression models were computed for cognitive tests at baseline and change in cognitive test scores to determine whether cognitive function was associated with two measures of insulin resistance, fasting insulin and homeostasis model assessment (HOMA). Linear regression models controlled for age, sex, race, marital status, education level, smoking status, alcohol use, depression, hypertension, and hyperlipidemia. RESULTS: In unadjusted and adjusted analyses, hyperinsulinemia based on fasting insulin and HOMA at baseline was associated with significantly lower baseline DWR, DSS, and WF scores and a greater decline over 6 years in DWR and WF. CONCLUSIONS: Insulin resistance is a potentially modifiable midlife risk factor for cognitive decline and dementia.

Practice patterns in sildenafil prescribing.

BACKGROUND: This study explores the incorporation of sildenafil into treatment of the common conditions of psychosexual and erectile dysfunction (ED). METHODS: The 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed for visits in which sildenafil was prescribed. Patient, visit, and provider characteristics for visits in which sildenafil was prescribed were compared between visits that documented a presenting complaint or diagnosis consistent with ED and those without documentation consistent with ED. RESULTS: Of visits by men 30 years or older receiving sildenafil, 50% had no documented presenting complaint or diagnosis consistent with ED. No significant differences were found between those prescribed sildenafil with or without a reason for visit or diagnosis of ED based on age, race, or payment type. Individuals with more visits in the last 12 months were significantly less likely to have a recorded diagnosis consistent with ED. Urologists documented ED significantly more often than family medicine, internal medicine, and other physicians. CONCLUSIONS: Sildenafil is being prescribed at a significant number of visits without documentation of a reason for visit or diagnosis consistent with psychosexual or erectile dysfunction.