What Constitutes Effective Team Communication After an Error?

Many procedures performed today involve a team of specialists with their own training histories and backgrounds. Some errors are inevitable in the course of clinical careers. Because errors tend to lead to complications, they often also lead to assignations of blame. When this happens, too often clinicians are at odds with each other about how to respond to a patient or a patient's loved ones after that patient suffers harm. This commentary on a case of a surgical complication examines how transparency in communication, cooperative disclosure, and working collaboratively to restore an injured patient's health support clinicians' common purpose, long-standing work relationships, and collegiality.

Quantification of stato-kinetic dissociation by semi-automated perimetry.

The difference in threshold sensitivities that are found when examining the visual field (VF) with static versus kinetic perimetric methods is called stato-kinetic dissociation (SKD). In this pilot study, we describe a semi-automated procedure for quantifying SKD. Fifteen patients with VF defects were examined with kinetic and static perimetry. SKD values were defined as positive when the static scotoma was larger than the kinetic one. We found significant local variations of SKD along scotoma borders with the individual reaction time as an important criterion when determining kinetic thresholds. There was a verifiable SKD in all patients with locally negative values in eight subjects.

Sildenafil-associated nonarteritic anterior ischemic optic neuropathy.

PURPOSE: To describe the clinical features of five patients who developed nonarteritic anterior ischemic optic neuropathy (NAION) after ingestion of sildenafil citrate (Viagra; Pfizer Pharmaceuticals, New York, NY). DESIGN: Retrospective observational case series. PARTICIPANTS: Five patients with NAION who reported the use of sildenafil citrate before the onset of ocular symptoms. MAIN OUTCOME MEASURES: The symptoms presented, history, ophthalmic examination, and visual field examination of each patient. RESULTS: Nonarteritic anterior ischemic optic neuropathy developed in one eye within minutes to hours after ingestion of sildenafil. Four of the five patients had no vascular risk factors for ischemic optic neuropathy. The patients all developed unilateral blurry vision, altitudinal visual field defects, and optic disc edema. Each of the patients was noted to have a small cup-to-disc ratio in the unaffected optic nerve. CONCLUSIONS: Sildenafil citrate may be associated with NAION. A small cup-to-disc ratio may be a risk factor for development of NAION in association with the use of sildenafil.