- Email: [email protected]
Incidence of oral human papillomavirus infection
Dr Klaus Boller/Science Photo Library
Correspondence
See Online for appendix
1554
at home from an aortic dissection. Debriefing with supervisors and peers was helpful, because most admitted they would have done the same. Yet the resident was left with an emotion that lasted for years and haunted many nights: regret. Such stories are common as clinicians make countless decisions and actions daily, often on the basis of complex and uncertain information, and under severe time pressure.1 Regret is the emotion that occurs when one feels another course of action would have led to a better outcome.2 Although involvement with perceived medical errors is common among medical students and residents,3 regret often stems from decisions and actions unrelated to errors.2,4 The effect of affective processes on health care has received little attention.5 Yet intense or repeated regrets might lead to sleep disorders,4 resulting in increased risk of future errors,3 and can influence decision making—eg, clinicians might order unnecessary tests.5 Regret is an unavoidable consequence of clinical practice. Whether its experience produces positive or negative consequences depends on the coping strategies clinicians use. Some strategies can act as powerful incentives to improve patient-centred care and lead to relevant changes in practice.4 By contrast, maladaptive coping strategies, such as suppression and rumination, can lead to sleep disorders, depression, and burnout, as well as to an over-acceptance of potentially preventable mistakes (appendix).2 Clinicians who make a mistake are now sometimes considered as second victims and provided with support to deal with their feelings of inadequacy and regret. We believe that all clinicians should be offered similar support for any decisions and actions that trigger strong negative feelings, even when they involve no medical error. Because prevention is better than cure, the best support could be the implementation of specific
training programmes on regretcoping strategies to protect clinicians from maladaptive strategies affecting their job and health, as well as to enhance quality improvement efforts. We declare that we have no conflicts of interest. We acknowledge support from the Swiss National Science Foundation and the University Hospitals of Geneva.
*Delphine Courvoisier, Arnaud Merglen, Thomas Agoritsas [email protected] Harvard University, Cambridge, MA 02138, USA (DC); The Hospital for Sick Children, Toronto, ON, Canada (AM); and McMaster University, Hamilton, ON, Canada (TA) 1 2
3
4
5
Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ 2009; 338: b1860. Courvoisier DS, Agoritsas T, Perneger TV, Schmidt RE, Cullati S. Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses. PLoS One 2011; 6: e23138. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA 2009; 302: 1294–300. Courvoisier DS, Cullati S, Haller C, et al. Validation of a 10-item care-related regret intensity scale (RIS-10) for healthcare professionals. Med Care 2013; 51: 285–91. Croskerry P, Abbass AA, Wu AW. How doctors feel: affective issues in patients’ safety. Lancet 2008; 372: 1205–06.
an oral rinse and gargle, whereas we used both an oral rinse and gargle and a self-collected swab of the back of the throat. In our paper, we also reported an incidence of 6·3% of oral HPV infection on the basis of the rinse-and-gargle method alone, which is closer to the 4·4% reported by Kreimer and colleagues. Pickard and colleagues3 estimated oral HPV incidence of 5·7 per 1000 personmonths using a rinse-and-gargle method in a cohort of male and female US college students followed up for 3 months—corresponding to a 6·8% annual incidence. The similarity between these incidence estimates suggests that, to date, there is little evidence that oral HPV infection risk varies greatly across studies that differ in the composition of their study populations. We declare that we have no conflicts of interest.
*Zoe R Edelstein, Stephen M Schwartz, Laura A Koutsky [email protected] HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY 10032, USA (ZRE); and Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA (SMS, LAK)
Incidence of oral human papillomavirus infection
1
Aimée Kreimer and colleagues (Sept 7, p 877)1 report an annual incidence of oral human papillomavirus (HPV) infection of 4·4% in an international cohort of men (aged 18–73 years; n=1626; specimen collection every 6 months). We would like to offer a methodological explanation for the difference between this estimate and our estimate of 12·3% from a cohort in Seattle, WA, USA (aged 18–24 years; n=212; specimen collection every 4 months).2 There are several potential explanations, including differences in study population, sample size, and specimen collection schedule. We suggest that one of the main reasons is the difference in specimen collection method. Kreimer and colleagues measured HPV DNA using
2
3
Kreimer AR, Pierce Campbell CM, Lin HY, et al. Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study. Lancet 2013; 382: 877–87. Edelstein ZR, Schwartz SM, Hawes S, et al. Rates and determinants of oral human papillomavirus infection in young men. Sex Transm Dis 2012; 39: 860–67. Pickard RK, Xiao W, Broutian TR, He X, Gillison ML. The prevalence and incidence of oral human papillomavirus infection among young men and women, aged 18–30 years. Sex Transm Dis 2012; 39: 559–66.
www.thelancet.com Vol 382 November 9, 2013
Correspondence
See Online for appendix
1554
at home from an aortic dissection. Debriefing with supervisors and peers was helpful, because most admitted they would have done the same. Yet the resident was left with an emotion that lasted for years and haunted many nights: regret. Such stories are common as clinicians make countless decisions and actions daily, often on the basis of complex and uncertain information, and under severe time pressure.1 Regret is the emotion that occurs when one feels another course of action would have led to a better outcome.2 Although involvement with perceived medical errors is common among medical students and residents,3 regret often stems from decisions and actions unrelated to errors.2,4 The effect of affective processes on health care has received little attention.5 Yet intense or repeated regrets might lead to sleep disorders,4 resulting in increased risk of future errors,3 and can influence decision making—eg, clinicians might order unnecessary tests.5 Regret is an unavoidable consequence of clinical practice. Whether its experience produces positive or negative consequences depends on the coping strategies clinicians use. Some strategies can act as powerful incentives to improve patient-centred care and lead to relevant changes in practice.4 By contrast, maladaptive coping strategies, such as suppression and rumination, can lead to sleep disorders, depression, and burnout, as well as to an over-acceptance of potentially preventable mistakes (appendix).2 Clinicians who make a mistake are now sometimes considered as second victims and provided with support to deal with their feelings of inadequacy and regret. We believe that all clinicians should be offered similar support for any decisions and actions that trigger strong negative feelings, even when they involve no medical error. Because prevention is better than cure, the best support could be the implementation of specific
training programmes on regretcoping strategies to protect clinicians from maladaptive strategies affecting their job and health, as well as to enhance quality improvement efforts. We declare that we have no conflicts of interest. We acknowledge support from the Swiss National Science Foundation and the University Hospitals of Geneva.
*Delphine Courvoisier, Arnaud Merglen, Thomas Agoritsas [email protected] Harvard University, Cambridge, MA 02138, USA (DC); The Hospital for Sick Children, Toronto, ON, Canada (AM); and McMaster University, Hamilton, ON, Canada (TA) 1 2
3
4
5
Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ 2009; 338: b1860. Courvoisier DS, Agoritsas T, Perneger TV, Schmidt RE, Cullati S. Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses. PLoS One 2011; 6: e23138. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA 2009; 302: 1294–300. Courvoisier DS, Cullati S, Haller C, et al. Validation of a 10-item care-related regret intensity scale (RIS-10) for healthcare professionals. Med Care 2013; 51: 285–91. Croskerry P, Abbass AA, Wu AW. How doctors feel: affective issues in patients’ safety. Lancet 2008; 372: 1205–06.
an oral rinse and gargle, whereas we used both an oral rinse and gargle and a self-collected swab of the back of the throat. In our paper, we also reported an incidence of 6·3% of oral HPV infection on the basis of the rinse-and-gargle method alone, which is closer to the 4·4% reported by Kreimer and colleagues. Pickard and colleagues3 estimated oral HPV incidence of 5·7 per 1000 personmonths using a rinse-and-gargle method in a cohort of male and female US college students followed up for 3 months—corresponding to a 6·8% annual incidence. The similarity between these incidence estimates suggests that, to date, there is little evidence that oral HPV infection risk varies greatly across studies that differ in the composition of their study populations. We declare that we have no conflicts of interest.
*Zoe R Edelstein, Stephen M Schwartz, Laura A Koutsky [email protected] HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY 10032, USA (ZRE); and Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA (SMS, LAK)
Incidence of oral human papillomavirus infection
1
Aimée Kreimer and colleagues (Sept 7, p 877)1 report an annual incidence of oral human papillomavirus (HPV) infection of 4·4% in an international cohort of men (aged 18–73 years; n=1626; specimen collection every 6 months). We would like to offer a methodological explanation for the difference between this estimate and our estimate of 12·3% from a cohort in Seattle, WA, USA (aged 18–24 years; n=212; specimen collection every 4 months).2 There are several potential explanations, including differences in study population, sample size, and specimen collection schedule. We suggest that one of the main reasons is the difference in specimen collection method. Kreimer and colleagues measured HPV DNA using
2
3
Kreimer AR, Pierce Campbell CM, Lin HY, et al. Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study. Lancet 2013; 382: 877–87. Edelstein ZR, Schwartz SM, Hawes S, et al. Rates and determinants of oral human papillomavirus infection in young men. Sex Transm Dis 2012; 39: 860–67. Pickard RK, Xiao W, Broutian TR, He X, Gillison ML. The prevalence and incidence of oral human papillomavirus infection among young men and women, aged 18–30 years. Sex Transm Dis 2012; 39: 559–66.
www.thelancet.com Vol 382 November 9, 2013