Prior research has identified an omission bias whereby third-party observers attribute greater intent, responsibility, and immorality to a transgressor for their harmful commissions than their harmful omissions. However, this research has not examined whether victims will also show an omission bias in response to an interpersonal transgression committed against them, and whether these perceptions affect the apology-forgiveness process. We conducted three experiments (Ns = 376, 593, 595) using complementary methods (hypothetical standardized offenses and real-life transgressions) to examine how and why commission and omission transgressions differentially affect victims’ forgiveness, and whether apologies are differentially effective at eliciting forgiveness for these transgressions. We found that forgiveness was generally lower for commission (vs. omission) transgressions. Moreover, victims perceived commission (vs. omission) transgressions as higher in responsibility and intent, and these offense perceptions in turn predicted reduced forgiveness, both on their own and serially through perceptions of immoral behavior and immoral character. However, apologizing (vs. not apologizing) predicted greater forgiveness for both types of offenses. These studies demonstrate how and why forgiveness might be less forthcoming for commissions, but suggest that apologies produce similar benefits following commissions and omissions.
Abstract Background Successful use of carbapenems in combination with cefazolin or oxacillin for treatment of MSSA bacteraemia has been described; however, comparative data to standard treatment approaches are lacking. Methods This was a multicentre, retrospective study of adult patients with MSSA bacteraemia for >48 h. Standard treatment was considered monotherapy with cefazolin, oxacillin or nafcillin. Combination therapy was defined as the addition of ertapenem or meropenem to standard treatment for at least 24 h. The primary outcome was duration of bacteraemia defined as time from administration of an antibiotic with in vitro activity to first negative blood culture. Time to blood culture sterilization was compared through risk-set matching with aid of a propensity score. Results Overall, 238 patients were included; 66% (157/238) received standard treatment and 34% (81/238) received combination therapy. The median (IQR) time to carbapenem initiation was 4.7 (3.63–6.5) days. Patients who received combination therapy were younger (P = 0.012), more likely to have endocarditis (P = 0.034) and had longer median duration of bacteraemia (P < 0.001). After applying risk-set matching, patients who received combination therapy experienced faster time to blood culture sterilization compared with control patients [HR = 1.618 (95% CI; 1.119–2.339) P = 0.011]. Using a paired hazard model, 90 day mortality rates were not statistically different among patients who received combination therapy versus matched controls [HR = 1.267 (95% CI; 0.610–2.678), P = 0.608]. Discussion Carbapenem combination therapy resulted in faster time to blood culture sterilization, but no differences in overall mortality rates. Randomized trials are critical to determine the utility of carbapenem combination therapy.
6000 Background: Reducing racial disparities in breast cancer survival has been a federal priority since the early 1990’s. We present a new method to assess disparities using sequential multivariate matching. We ask if racial disparities have increased or decreased over time and if so, what were potential reasons for such changes. Methods: We studied all women over 65 years of age in the Medicare fee for service system diagnosed with breast cancer between 1991 and 2005 who were treated in one of 12 SEER sites (the sites in SEER since 1991). There were 5,251 black patients (74% early stage (I-III), 9% late stage (IV) and 17% missing stage) and 72,695 white patients (81% early stage, 5% late stage and 14% missing stage). All black cases represented the focal group for all matches. Using multivariate matching and the propensity score, white controls were matched to blacks in steps: (1) White controls matched to black cases on age and year of diagnosis; (2) Age, year of diagnosis, and stage; (3): Age, year, stage, estrogen receptor status, grade, and 30 comorbidities. We then compare 5-year survival in the Pre and Post-Taxane periods (1991-1998, 1999-2005). Results: When whites were matched to blacks on age and diagnosis year, 5-year Kaplan-Meier survival was 69.2% vs. 56.7%, P < 0.0001. Matching additionally on stage, differences = 64.1% vs. 56.7%, P < 0.0001; Matching further on tumor characteristics and 30 comorbidities, the disparity reduced to 61.6% vs. 56.7%, P < 0.0001. Comparing trends over time, white-black differences in survival matched for age and year were 67.6% vs. 55.2% (P < 0.0001) in the pre-Taxane era (difference = 12.4%) and 71.2% vs. 58.7% (P < 0.0001) in the post Taxane era (difference = 12.5%); age and year matched paired racial differences were not different across eras (P = 0.389). Conclusions: While there may have been some improvements in overall survival, racial disparities in breast cancer survival have not improved, despite important policy initiatives and treatment advances. Adjusting for presentation at diagnosis does reduce differences in survival, but even these differences remain large and significant, suggesting that differences in both presentation and treatment given presentation are contributing to this disparity.
Differences in colon cancer survival by race are a recognized problem among Medicare beneficiaries.To determine to what extent the racial disparity in survival is due to disparity in presentation characteristics at diagnosis or disparity in subsequent treatment.Black patients with colon cancer were matched with 3 groups of white patients: a "demographic characteristics" match controlling for age, sex, diagnosis year, and Survey, Epidemiology, and End Results (SEER) site; a "presentation" match controlling for demographic characteristics plus comorbid conditions and tumor characteristics, including stage and grade; and a "treatment" match, including presentation variables plus details of surgery, radiation, and chemotherapy.16 U.S. SEER sites.7677 black patients aged 65 years or older diagnosed between 1991 and 2005 in the SEER-Medicare database and 3 sets of 7677 matched white patients, followed until 31 December 2009.5-year survival.The absolute difference in 5-year survival between black and white patients was 9.9% (95% CI, 8.3% to 11.4%; P<0.001) in the demographic characteristics match. This disparity remained unchanged between 1991 and 2005. After matching for presentation characteristics, the difference decreased to 4.9% (CI, 3.6% to 6.1%; P<0.001). After additional matching for treatment, this difference decreased to 4.3% (CI, 2.9% to 5.5%; P<0.001). The disparity in survival attributed to treatment differences made up only an absolute 0.6% of the overall 9.9% survival disparity.An observational study limited to elderly Medicare fee-for-service beneficiaries living in selected geographic areas.Racial disparities in colon cancer survival did not decrease among patients diagnosed between 1991 and 2005. This persistent disparity seemed to be more related to presentation characteristics at diagnosis than to subsequent treatment differences.Agency for Healthcare Research and Quality and National Science Foundation.
Among consecutive patients with multidrug-resistant Pseudomonas aeruginosa bacteremia or pneumonia we found those treated with ceftazidime-avibactam were more likely to develop resistance (defined as ≥4-fold increased MIC) than those treated with ceftolozane-tazobactam (40% vs 10%; P = .002). Ceftazidime-avibactam resistance was associated with new mutations in ampC and efflux regulatory pathways.
Apologies are powerful predictors of reconciliation, but transgressors often fail to offer optimal, high-quality apologies that are comprehensive and non-defensive. We tested whether intellectual humility and general humility predict the use of high-quality apologies versus taking no action to resolve a conflict, and the processes that mediate these associations using online vignette experiments. In Study 1 (N = 397), transgressors with greater intellectual humility offered higher-quality apologies and were less likely to take no action following a relational offense. However, these associations did not remain significant when controlling for general humility. In Study 2 (N = 394), intellectual humility uniquely predicted greater apology comprehensiveness and less inaction following an intellect-based offense, demonstrating its context-specific associations with apology behavior. By contrast, general humility was a robust predictor of higher-quality apologies and less inaction across offense contexts. Consistent with recent theorizing on psychological barriers to apologizing, both studies also found support for the mediating roles of empathic effort and self-protection.
Objective To develop a method to allow a hospital to compare its performance using its entire patient population to the outcomes of very similar patients treated elsewhere. Data Sources/Setting Medicare claims in orthopedics and common general, gynecologic, and urologic surgery from Illinois, New York, and Texas from 2004 to 2006. Study Design Using two example “focal” hospitals, each hospital's patients were matched to 10 very similar patients selected from 619 other hospitals. Data Collection/Extraction Methods All patients were used at each focal hospital, and we found the 10 closest matched patients from control hospitals with exactly the same principal procedure as each focal patient. Principal Findings We achieved exact matches on all procedures and very close matches for other patient characteristics for both hospitals. There were few to no differences between each hospital's patients and their matched control patients on most patient characteristics, yet large and significant differences were observed for mortality, failure‐to‐rescue, and cost. Conclusion Indirect standardization matching can produce fair audits of quality and cost, allowing for a comprehensive, transparent, and relevant assessment of all patients at a focal hospital. With this approach, hospitals will be better able to benchmark their performance and determine where quality improvement is most needed.
Objective: To characterize patterns of healthcare utilization before and after surgery and determine any association with pre-operative frailty. Summary Background Data: Frail patients experience worse post-operative outcomes and increased costs during the surgical encounter. Evidence is comparatively lacking for longer-term effects of frailty on post-operative healthcare utilization. Methods: Retrospective, longitudinal cohort analysis of adult patients undergoing any elective surgical procedure following pre-operative frailty assessment with the Risk Analysis Index (RAI) from 02/2016-12/2020 at a large integrated healthcare delivery and financing system. Group-based trajectory modeling of claims data estimated distinct clusters of patients with discrete utilization trajectories. Multivariable regression predicted membership in trajectories of interest using preoperative characteristics, including frailty. Results: Among 29,067 surgical encounters, four distinct utilization trajectories emerged in longitudinal data from the 12 months before and after surgery. All cases exhibited a surge in utilization during the surgical month, after which most patients returned to “low” [25,473 (87.6%)], “medium” [1,403 (4.8%)], or “high” [528 (1.8%)] baseline utilization states established before surgery. The fourth trajectory identified 1,663 (5.7%) cases where surgery occasioned a transition from “low” utilization before surgery to “high” utilization afterward. RAI score alone did not effectively predict membership in this transition group, but a multivariable model with other preoperative variables was effective (c=0.859, max re-scaled R-squared 0.264). Conclusions and Relevance: Surgery occasions the transition from low to high healthcare utilization for a substantial subgroup of surgical patients. Multivariable modeling may effectively discriminate this utilization trajectory, suggesting an opportunity to tailor care processes for these patients.
