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The PSNet Collection: All Content

The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.

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Displaying 1 - 6 of 6 Results

Lockshin MD, Crow MK, Barbhaiya M, eds. Springer Nature: Cham, Switzerland; 2022.  ISBN 9783031049347. 

Clinicians interpret a variety of elements that contribute to diagnostic complexity and ambiguity. This book examines the presence of uncertainty in the process of diagnostic decision making, including the lack of widely agreed upon condition definitions.
Liebowitz J. N Engl J Med. 2022;386:2456-2457.
Diagnostic errors caused by premature closure and anchoring bias occur when clinicians rely on initial diagnosis despite receiving subsequent information to the contrary. This commentary encourages clinicians to be aware of their cognitive biases during the diagnosis process.
Stonington S, Coffa D. N Engl J Med. 2019;380:701-704.
The authors describe how increasing complexity and bureaucracy associated with opioid prescribing led a patient with chronic pain that had been previously well controlled on a stable dose of acetaminophen–hydrocodone for many years to experience job insecurity, withdrawal symptoms, and uncontrolled pain, which ultimately prompted him to seek opioids illegally. The authors refer to this type of harm as "structural iatrogenesis."
WebM&M Case May 1, 2018
An elderly man with a history of giant cell arteritis (GCA) presented to the rheumatology clinic with recurrent headaches one month after stopping steroids. A blood test revealed that his C-reactive protein was elevated, suggesting increased inflammation and a flare of his GCA. However, his rheumatologist was out of town and did not receive the test result. Although the covering physician saw the result, she relayed just the patient's last name without the medical record number.
Schmajuk G, Yazdany J. Rheumatol Int. 2017;37:1603-1610.
Electronic health records have both safety benefits and unintended consequences. This review discusses safe management of rheumatoid arthritis in the ambulatory setting and highlights the need to capitalize on tools in electronic health records to enhance medication safety for the patients with rheumatoid arthritis.