In the aftermath of medical error : Caring for patients, family, and the healthcare workers involved

Medical errors, in particular those resulting in harm, pose a serious situation for patients ("first victims") and the healthcare workers involved ("second victims") and can have long-lasting and distressing consequences. To prevent a second traumatization, appropriate and empathic interaction with all persons involved is essential besides error analysis. Patients share a nearly universal, broad preference for a complete disclosure of incidents, regardless of age, gender, or education. This includes the personal, timely and unambiguous disclosure of the adverse event, information relating to the event, its causes and consequences, and an apology and sincere expression of regret. While the majority of healthcare professionals generally support and honest and open disclosure of adverse events, they also face various barriers which impede the disclosure (e.g., fear of legal consequences). Despite its essential importance, disclosure of adverse events in practice occurs in ways that are rarely acceptable to patients and their families. The staff involved often experiences acute distress and an intense emotional response to the event, which may become chronic and increase the risk of depression, burnout and post-traumatic stress disorders. Communication with peers is vital for people to be able to cope constructively and protectively with harmful errors. Survey studies among healthcare workers show, however, that they often do not receive sufficient individual and institutional support. Healthcare organizations should prepare for medical errors and harmful events and implement a communication plan and a support system that covers the requirements and different needs of patients and the staff involved.

The Hypereosinophilic Syndromes in Childhood.

The hypereosinophilic syndromes are rare disorders in childhood and require extensive differential diagnostic considerations. In the last years the earlier "idiopathic HES" called syndromes could be differentiated into molecular biologically, immunophenotypically and clinically more characterized heterogeneous diseases with high therapeutic and prognostic relevance. Nowadays the term HES summarizes diseases, which go hand in hand with a local or systemic hypereosinophilia (HE) connected with an organ damage. Depending on the cause of the HE one differentiates primary/neoplastic HES (HESN) from secondary/reactive HES (HESR). The latter develops reactively in connection with allergies, parasitosis, medications, neoplasia or a clonal increase of T-lymphocytes among others. With HESN the HE results from a clonal increase of eosinophilic granulocytes. While for some subgroups of the HESN (among others FIP1L1-PDGFRA fusion gene) the administration of a tyrosine kinase inhibitor is a new and effective therapy option, glucocorticoids still represent the medication of first choice for many not PDGFRA associated variants. Different immunomodulatory drugs or cytostatic agents are necessary to allow dose reduction of glucocorticoids. The promising therapy with anti-IL-5 antibodies is still not approved in infancy, could however become a treatment option in the future. Due to the present lack of knowledge about the HES in infancy the establishment of a register should be aimed for the treatment of HES in infancy.

Selbstbereicherung an kollektiven Ressourcen. «Eigennutz» als Leitmotiv politischer und sozialer Skandalisierung in der vormodernen Eidgenossenschaft

Angemessen historisiert kann der «Skandal» auch für die Vormoderne als produktive Forschungskategorie genutzt werden, um nach fundamentalen Wertehaltungen und zugehörigen Konfliktmodi zu fragen. Während Skandale in heutiger Zeit über massenmedial verbreitete Enthüllungen befeuert werden, adressierte Skandalisierung in der Vormoderne unterschiedliche Kommunikationsräume wie etwa Familie, Peer Groups, politische Gremien und Versammlungen, die als ständisch gerahmte, ineinander verschachtelte und miteinander interagierende Teilöffentlichkeiten fungierten. Eigentliches Skandalon stellte der Vorwurf des Eigennutzes bzw. die Schädigung des gemeinen Nutzens dar. Angeprangert wurden Selbstbereicherung, undurchsichtige Machenschaften oder übermässige Profite aus Amtstätigkeiten. Skandalen kam dabei die Funktion von Läuterungsritualen zu, welche lokalen Gesellschaften und ständischen Gruppen die ungeschriebenen Gesetze ihres Zusammenlebens in Erinnerung riefen.