Iatrogenesis

The adoption of systems-focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems, and provide no direct support for designing and managing solutions (i.e., risk control). This second installment of a 2-part series on rebalancing risk management describes a structured approach to bridging this gap: The Active Risk Control (ARC) Toolkit. A pilot study is presented to show how ARC Toolkit can improve the quality of risk management practice.

The main focus of the present thesis is to critically examine concepts and practices of community mental health in the modality of modern psychiatry, as the context to shed light on significance of folk psychiatry in tribal community of Arunachal Pradesh, and also on its relevance for the betterment of community mental health in general. The thrust is given more on the praxis involved in community mental health reflecting the phenomena of de-institutionalization and psychiatric iatrogenesis. Upon the issues, contextual part of the thesis engaged engages with configurational analysis of human acts over the modern deployment of institutionalization and medicalization as responses to mental disorder, with emphasis on the relationality between episteme; internal frame of reference on the thoughts, behaviors and acts on the process, and the tangible structural constructs,; such as judiciary, bureaucracy, industry, legislation, media and academics as the reflexions. Deinstitutionalization has been understood generally as if it is natural, transitional and corollary process of mental health development, however the present study holds different view. Thise meta analysis comprehends the phenomena in retrospective, as a consequence of overdriven detour of modernization mania and a manifestation of its system failure. Iatrogenesis has expandeds along with insatiate medicalization of life, particularly with a belief system of scienticism, mindlessly employed for the market based medicine. The This conversion of normalcy into morbidity and disease manufacturing has been successful with expansion of industrial empire and mounting mental disorder worldwideglobally through well designed propaganda swallowing all sorts of pain and distress into the pill. The similar consequence of overdrive will be in the place in the course of time with the enormity of the nemesis as by-product of globalizing bio-bio-bio- psychiatry. No longer the fire remain on the side shore of ‘developed’ nations in global north, the evidences in this study suggest proactive preparedness against impending human disaster and caution probable hazard from adverse effects of both antipsychotics and development.

In this backdrop, an intensive investigation made for the thesis highlights the state prior to these two interventions in order to understand how human could be healthier in initial condition where the cognition distinguishes no clear and distinct division between the subject and the object, the individual and the community, the human and the nature, and the soul and the spirit, physical and mental, the formal and the informal, modernity and tradition and the self and the other. The continuity and integrity still holds the vestige in the most remote corner of the world, thus an extensive field work examinexaminesed the modality and methodology in terms of mental health praxis among tribal communities of the Tani group of scheduled tribal peopletribe  in Arunachal Pradesh. The main exploration was is on the original meaning of psychiatry, i.e. “a healing of the soul” “which derived from Latinized form of Greek psyche-“mind/soul ” and iatreia” “care/healing”, in the context and concept of informal, unnamed knowledge system and their application to the mental health and illness. The inquiry strives more on the aspect of salutogenesis in the community, through the integral mode of healing, and caregiving and coping as therapeutic, rehabilitative and preventive mechanism, and their art and techne are placed at focal points of the scrutiny. Contrary to the dominant stand of public health discourse universalizing the morbidity all the more, the literally naïve population, unexposed to the influence of neuroleptics and psychiatric service, has shown profoundly less prevalence of mental disorder, as low as 0.012% among the Apatanis, one of Tani tribe, which and the rate represents the high potentiality and capacity and competence of biotechnology and hospital free milieu. The relative betterment of mental wellbeing also implies the significance intricately connected social fabric and bond, wealthy property nurturing the life lives and well organized support system in crisis management. The smallness of the number is more intriguing in consideration of the fact that the Apatani community is commonly construed with more possible prevalence than other tribal group in the locale, both in internal view of the Apatani themselves and external impression of neighboring community. However, the thesis does not defy all the cure of antipsychotics and psychotherapies in view of endogenous cases which was the most in the field, however, the primary findings of the thesis suggest further potency of the innate praxis ingrained in the deep root of the costa connected to the initial condition state of humanity and its culture, and also the appropriateness and adequacy of these the time testedtime-tested soul healing ‘folk psychiatry’, which’ await more substantial and considerable studies to be undertaken to for contributeion  of actual development ofin community mental health for all.

Unlike psychiatric drugs, psychotherapy is generally assumed to be safe and have little or no harmful side effects (Lilienfeld, 2007). In this paper, I show that this assumption is contrary to evidence in the scholarly literature. Iatrogenic effects of psychotherapy are, in fact, well documented and even include death. Potential sources of iatrogenic harm in psychotherapy are: medicalizing and pathologizing ordinary human emotions, altering a client’s beliefs about the nature of their suffering, and learned dependence on the therapist. If therapists wish to help clients deal with emotional suffering, they must be aware of the potential for unintended harm. Just as psychotherapists bring awareness to the negative forces affecting a client’s emotional state, so too therapists must be made aware of the negative forces affecting the practice of psychotherapy.

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.

The medicalisation thesis argues that medical science has diminished people's ability to cope with pain, suffering and death . In the arena of childbirth, medicalisation is seen as disempowering women to the extent that they struggle with the challenges of motherhood . This article will explore the medicalisation thesis as applied to childbirth, through data arising from qualitative interviews with mothers in Walthamstow, East London. It will argue that childbirth matters for women, and the way in which they give birth -whether it is highly interventionist or not, whether they feel in control or not -has long-term consequences for their emotional, psychological and physical health, their relationships and their babies. It will also propose that various localised systems of support are key to women's adjustment to motherhood, whether they have had traumatic, difficult or good births.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

KEYWORDS: Healthcare, health information technology, planning, error, iatrogenesis, risk management, failure mode effect analysis, root cause analysis, diffusion of innovation theory, rogers, complexity theory, complex adaptive systems, organizational development, patient safety, change management, human factors, ivan illich, medical nemesis.

Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children's experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational-technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Avoidable patient harm is a major public health concern, and may already have surpassed heart disease as the leading cause of death in the US. While the public health community has contributed much to one aspect of patient harm prevention, infection control, the tools and techniques of public health have far
more to offer to the emerging field of patient safety science. Patient safety practice has become increasingly professionalized in recent years, but specialist degree programs in the field remain scarce. Healthcare organizations should consider graduate training in public health as an avenue for investing in the professional development of patient safety practitioners, and schools and programs of public health should support further research and teaching to support patient safety improvement.

This presentation explores unintended harm caused by well-meaning practitioners (also known as iatrogenesis). At the political level (macro), the UK government introduced policies such as IAPT to meet the demand for therapeutic services. These services are implemented through our professional bodies (meso level), and impact upon the space where clients and therapist meet each other (micro level).

Research suggests that as a group, therapists’ self-perception of their effectiveness seems to be over-rated. We will ask whether psychotherapy training informs practice or if a taboo exists regarding the topic of iatrogenesis. We will then consider the match, or mismatch, between our own personal philosophies and practices. Future research will be proposed, followed by questions and explorations.

Oxytocin, a uterotonic that works to induce labor, expedite delivery, and reduce post-partum hemorrhage, has in recent decades become a key component of Pakistan’s public health sector’s arsenal of essential drugs. Despite ample proof of oxytocin’s life-saving properties, there is growing global evidence of its increasingly widespread counter-protocol uses, and the life-threatening complications these produce. With the literature for South Asia predominantly focused on the ways that its misuse results from the knowledge and practice deficits typical of untrained or low-skilled birth attendants working at the community level, we know far less about oxytocin’s misapplications by skilled providers in hospital settings. Through ethnography of oxytocin’s actual uses in government hospitals in northern Pakistan, my paper attempts to correct this gap, and explores the drug’s non-medical advantages and sometimes-dire medical disadvantages. By analyzing its correlations with uterine rupture, post-partum hemorrhage, and birth asphyxia, for instance, my research may explain why high local rates of obstetric injury, illness, and death persist even despite Gilgiti women’s near-total recourse to hospitals for labor and delivery. Equally, in considering oxytocin’s use against the backdrop of the hospital and its shortfalls, my paper confirms that non-medical or medically inappropriate forms of oxytocin use were neither isolated nor unusual clinical events, but quotidian extensions of the structural violence inherent to Pakistan’s public health services.

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis’ immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.

Drawing on fieldwork with the veterinary staff at an Indian wildlife sanctuary, this paper examines the controversy surrounding an epizootic outbreak of tuberculosis among a population of sloth bears. As these bears fell ill and began to die, the veterinary staff asked whether they might be culled, inciting allegations of incompetence and cruelty from both the media and government bureaucrats. This paper works through a series of ethico-legal questions regarding the cullability of these tuberculous bears, which depended in part on how the bears were classified-as wild or domestic, captive or free, curable or incurable. As boundary-crossing figures, the bears confounded straightforward efforts at classification, rendering their fates open to debate. In treating them, the veterinary staff feared that they were only extending their suffering, producing a form of life that might be thought of as iatrogenic. In this light, this paper suggests that cruelty-both the cruelty of culling and that of treatment-might be figured as an unavoidable aspect of the relation of dependency between animals and their human caretakers.

Emergency psychiatry does not seem to have a consolidated identity as are other sub specialties in psychiatry. There is neither consensus on where the service is to be provided, which specialty is to manage, and who qualifies as an emergency psychiatry patient. There is also no formal certification, only self directed courses that struggle to keep up with the onslaught of demand for certification and specialization.  Patients pay the price especially in countries where anti dumping laws and regulations do not exist or are not enforced and where psychiatric patients are the lowest in the priority of hierarchies of the health care system.
Material & Method
A model of work was implemented for three months.  Its pros and cons are presented and compared to other models of service and training.  Different institutional methods of covering up iatrogenic harm and the risk of whistleblowing
Results
Challenges that face patients and providers (both the  institutional challenges and physician) are presented.  The risks of not addressing this rising need are exposed. Conclusions
It is time to make Emergency Psychiatry a priority in training. It is also time to revive the fiduciary nature of the contract between health providers and health seekers.  Every incident in which a patient is harmed, either by self in the context of the hospital or by the health providers, is a sentinel event and no waiting for "statistically" significant numbers needs to be introduced as a paradigm of thinking. Patient dumping and covered up iatrogenic harm are particularly addressed as they undermine the ethical code of conduct

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational-technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology-organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

Australia could use the long established US VICP (vaccine injury compensation program) as a template for implementing its own VICS (vaccine injury compensation scheme). A VICS requires a dedicated vax-injury compensation agency. It requires a national dedicated and centralised vax-injury collection database (not data filtered through various State government lenses, as with the present DAEN). And the public and researchers need transparent VICS data that is timely and open-access. Australia’s VICS could be funded by a vax-tax of, say, $1 per distributed vax dose. In the USA, of the total vax injury claims filed (n= 22,372), 94% were claims for non-fatal injury (n=21,035) and 6% were claims for death (n=1,337). In Australia, the Database of Adverse Event Notifications (DAEN) records 17,835 vaccine adverse event reports, including 54 deaths, across 69 approved vaccines (1971-2020). Eleven of the vax-deaths are recorded as due to “Injury, poisoning and procedural complications”, with six described as “vaccination failure”and five as “vaccination error”. There are 157 different adverse outcomes categorised. The unprecedented speed of Covid vax deployment has engendered some consumer resistance, with “58 per cent of the French population are sceptical of getting the Covid-19 vaccine, compared with 33 percent of people in the UK and 41 percent in the US”. An Australian VICS would not directly address public vax scepticism (the World Health Organisation calls it “vaccine hesitancy”), however a VICS enables vax-harms to be acknowledged and compensated.

Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions. Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique. Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group. Proportion of NARCOs decre...

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.