Miracle-dz/UniFAR-FTUs huggingface dataset:
Self‐assessment of practice performance: Development of the ABIM Practice Improvement Module (PIMSM)

Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIMSM) and the average performance of ABIM diplomates who have completed the Preventive Cardiology PIMSM. Design: Observational study of self‐administered practice quality improvement. Setting: Office practices through the United States. Participants: A total of 179 cardiologists and general internists completing requirements for ABIM Maintenance of Certification from 2004 through 2005. Measurements: Physicians self‐audited at least 25 charts to obtain performance measures, patient demographics, and coronary heart disease risk factors. At least 25 patients completed surveys regarding their experience of care in the physician's practice. Physicians completed a self‐assessment survey detailing the presence of various practice systems. Results: The mean rate for systolic blood pressure control was 48%, for diastolic blood pressure 84%, and for low‐density lipoprotein (LDL) cholesterol at goal 65%. Of patients 61% rated the quality of care as excellent and 58% rated the practices excellent at encouraging questions and answering them clearly. More than 85% of patients reported “no problem” obtaining a prescription refill, scheduling an appointment, reaching someone in the practice with a question, or obtaining lab results. Targets for improvement were increasing the rates for LDL cholesterol or systolic blood pressure at goal, improving patients' physical activity, patient education, and accuracy of risk assessment. Improvement strategies included implementing chart forms, patient education, or care management processes. Limitations: Patients and charts were selected by physicians reporting their performance for the purpose of MOC. Conclusions: The Preventive Cardiology PIMSM successfully provides a self‐assessment of practice performance and provides guidance in helping physicians initiate a cycle of quality improvement in their practices.
Medical Classics: One Flew Over the Cuckoo's Nest

Set in 1963, this landmark film took viewers into the heart of a typical psychiatric ward and exposed the realities therein. Based on the 1962 novel by Ken Kesey, it tells the story of Randle P McMurphy—an immoral, self centred delinquent who feigns insanity to avoid serving a custodial sentence on a work farm. Not realising that his release from the hospital is dependent on a sound psychiatric report, he decides to instigate his own brand of mayhem to pass the time and “show them who's nuts! ” His antics backfire when his doctors classify him as dangerous, but not necessarily mad, and he is subsequently detained on the ward for further management. During this period, McMurphy continues to taunt the orderly, maternal, authoritarian Nurse Ratched, who seeks to maintain the ward routine that he so desperately tries to disrupt. When a fight breaks out on the ward and McMurphy assaults a staff member, he is sent for electroconvulsive therapy—a scene as graphic as it is disturbing. The central conflict in the drama is between McMurphy and his nemesis Nurse Ratched. Initially she seems caring and sensitive but is shown ultimately to be just as manipulative as McMurphy, especially in the searing penultimate scene after a drunken impromptu ward party. The supporting characters are equally intriguing and include the vulnerable, stuttering Billy Bibbit; the elective mute native American Indian chief Bromden; the misunderstood, suspicious intellectual Harding; and Cheswick, a middle aged man unable to face the real world. Thoughtfully filmed in Oregon State Hospital, where the superintendent not only allowed filming on an empty ward but also played the role of the consultant psychiatrist, this film is littered with themes of power, autonomy, and consent. It is therefore an ideal film to study with our medical students as it serves as an accessible template for the discussion of these important issues. We debate whether Nurse Ratched is a “personification of evil” (she was named the fifth greatest villain in film history by an American Film Institute poll in 2003) and whether McMurphy is mad. We discuss whether such a character, with features of antisocial personality disorder (irresponsible, impulsive, difficulty maintaining relationships) and who is deemed dangerous (by a panel of psychiatrists), could be detained against his will if the proposed new mental health laws were passed in the UK. However, this film didn't win academy awards for best actor, best actress, best screenplay, best director, and best film because of the breadth of ethical issues it covered—it was successful because it is both thought provoking and entertaining. This is a film that can make you laugh, cry, and shout at the screen. It is regarded by many (including us) to be a true classic.
Comparison of evidence‐based practice between physicians and nurses: A national survey of regional hospitals in Taiwan

Introduction: Although evidence‐based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. Methods: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551 nurses during February to May 2007. Results: Physicians were more aware of EBP than nurses. Although both groups had high recognition of belief in and favorable attitudes toward EBP, their knowledge of and skill in EBP were relatively low. When compared with nurses, physicians were more willing to support the promotion of EBP implementations in clinical services. Physicians' knowledge and skills regarding the application of EBP principles were greater than nurses. Furthermore, physicians more often accessed the on‐line evidence‐retrieval databases, including the Cochrane Library. The most commonly ranked barriers to EBP applications for both groups included lack of designated personnel, lack of convenient kits, limited basic knowledge of EBP, and time. In general, nurses generated more barriers than physicians. Discussion: There were significant discrepancies between physicians and nurses in their awareness of, attitude toward, knowledge of, skill in, behavior toward, and barriers regarding EBP. In implementing EBP, strategies to overcome barriers and provide on‐line evidence‐retrieval systems should differ for physicians and nurses.
Teaching Tobacco Cessation Skills to Uruguayan Physicians Using Information and Communication Technologies

Introduction: Since 2004, with the ratification of the Framework Convention on Tobacco Control, Uruguay has implemented a wide range of legal restrictions designed to reduce the devastating impacts of tobacco. This legal process generated an increase in demand for tobacco cessation treatment, which led to the need to train a large number of physicians. Information and Communication Technologies (ICTs) are evolving constantly, creating new opportunities to make online education more interactive. The evolution of ICTs presents an opportunity to develop innovative continuing medical education (CME) experiences to meet the increasing demand for this topic. Methods: A blended‐learning course on tobacco cessation was developed and implemented, combining face‐to‐face and online activities. Educational strategy focused on (1) facilitating interaction among generalists and between generalists and experts, and (2) providing high impact CME incorporating multifaceted interventions with wiki‐type collaborative construction of practical knowledge. Multiple‐choice tests and commitments‐to‐change were used for evaluation. Results: Three hundred thirty‐five health professionals participated in the course. Of these, 145 (43.3%) attended the on‐site workshop, 216 (64.5%) participated in the online activities, and 109 (32.5%) completed both phases. Fifty of the 105 (47.6%) participants completing the pretest had a passing score, while 78.1% received a passing score on the final test (p < .001). Differences between mean pretest and posttest scores among those who completed both phases compared with those who only did the online phase were statistically significant (p = .003 and p = .009, respectively). Discussion: The need to train physicians on tobacco cessation skills can be addressed via ICTs and educational activities that include participant interaction.
A randomized, double‐blind, dose‐ranging, pilot study of intravenous granisetron in the prevention of postoperative nausea and vomiting in patients undergoing abdominal hysterectomy1

Background and objective: Postoperative nausea and vomiting (PONV) is a frequent and unpleasant experience that may increase postoperative complications and costs. For surgical procedures with a high risk of PONV, prevention is preferable to treatment. In this study, the authors explore the dose‐response relationship between granisetron administered just prior to the end of surgery and post‐operative nausea and vomiting in patients undergoing abdominal hysterectomy. Methods: This was a randomized, double‐blind, placebo‐controlled, pilot study of post‐operative nausea and vomiting prevention. Patients undergoing elective open abdominal hysterectomy requiring general anaesthesia received a single dose of granisetron 0.1, 0.2 or 0.3 mg or placebo administered approximately 15 min prior to the end of surgery. The primary efficacy end‐point was the proportion of patients with no vomiting in the 0‐6 h interval following medication administration. No inferential statistics were planned. Results: The proportion of patients with no vomiting episode in the 0‐6 h interval after administration of study medication was higher in each granisetron treatment group (>90%) than in the placebo group (77%). Proportions of patients with no vomiting episodes in the 0‐24 h interval were similar across treatment groups. Results of analyses of proportions of patients with no moderate or severe nausea episodes, proportions of those requiring rescue medication and times to first use of rescue medication suggested a treatment effect of granisetron relative to placebo in both the 0‐6 and 0‐24 h intervals. Similar proportions of patients in each treatment group reported at least one adverse event. Conclusions: Granisetron at doses of 0.1, 0.2 and 0.3 mg administered just prior to the end of surgery suggested a trend of improved efficacy compared to placebo in preventing postoperative nausea and vomiting in the first 6 h after abdominal hysterectomy. This pilot study did not identify a dose‐response relationship.
Long-Term Trends in Clinical Social Work

In this article, I examine four interrelated trends that have emerged in clinical social work over the past half-century: the increasing variety of interventions used by clinical social workers; the emergence and solidification of short-term modalities; the development of action-oriented methods; and the growing importance of research as a basis for practice. I consider selected developments, issues, and implications relating to these trends, including the emergence of posteclectic, problem-specific intervention models concomitant with the fading importance of the "schools" approach to practice; applications of brief treatment methods in the context of a managed care environment; the struggle to achieve an appropriate balance between actionoriented and reflective-expressive approaches; and the growing evidence for differential intervention effects as part of the increasing role of research as a guide to practice.
Demoralization in Health Professional Practice: Development, Amelioration, and Implications for Continuing Education

&NA; Demoralization is a feeling state of dejection, hopelessness, and a sense of personal “incompetence” that may be tied to a loss of or threat to one's own goals or values. It has an existential dimension when beliefs and values about oneself are disconfirmed. Numerous sources describe high rates of dissatisfaction and burnout in physicians and other health professionals. This article reviews historical and empirical findings that describe the professional and personal value orientations of physicians and other health professionals. It reviews empirical and theoretical findings to consider the implications of conflict between these values and negatively perceived ethical and values orientations of health care organizations and commercial health care entities. Conflicts between personal and professional values of health professionals and larger health care related organizations and commercial entities with which they are associated may contribute to the development of demoralization and burnout. Physicians and other health professionals frequently experience values related conflicts with larger social, organizational or bureaucratic systems. These conflicts place health professionals at risk for demoralization and burnout. “Remoralization,” or renewal of morale, depends on the reestablishment of the potential for fulfillment of one's values in the work environment. This depends on organizational, group, and personal efforts. Continuing education and continuing professional development programs should have a programmatic focus on the importance of a values orientation in health care and support program development aimed at recognizing, addressing, and reducing demoralization and its potential for negative health care consequences for health professionals and patients.
Users and radical innovation performance: the moderating role of the organisational context

ABSTRACT This study investigates four key factors of the internal organisational context that moderate the relationship between connecting with users and radical innovation performance: performance management, autonomy, internal networking and organisation and culture to support innovation. These components define a firm's organisational context. A sample of Austrian- and Italian-based firms shows that the connecting with users–radical innovation performance relationship is amplified at higher levels of all the investigated elements of the organisational context. The authors discuss the study's implications as well as future research directions.
Public Health and Medical Preparedness for a Nuclear Detonation: The Nuclear Incident Medical Enterprise

AbstractResilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a “bottom-up” systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.
An adapted TPB approach to consumers’ acceptance of service-delivery drones

ABSTRACT Organisations and marketers have long debated the consumer–brand relationship. Theorising related to this debate led to self-service technologies, which were implemented to both reduce costs and increase productivity by turning customers into co-producers of services or merely to keep up with technological developments. With the emergence of disruptive technologies, it is imperative to discuss the potential shift from a customer co-created value to a customer–technology relationship that could disrupt the value-based relationship model. In line with advancements in service-delivery drones, and based on the theory of planned behaviour framework, this paper pioneers the discussion on consumers’ intention to accept their use based on their related perceived risks, potential functional benefits, and relational attributes, leading to a new type of relationship with the brand – namely, the customer–drone relationship. This discussion opens a new direction for retailers and academics alike to reflect on during the coming years.
Proposed Modification to the Plutonium Systemic Model

AbstractThe currently accepted biokinetic model for plutonium distribution within the human body was recommended by the International Commission on Radiological Protection in publication 67. This model was developed from human and animal studies and behavioral knowledge acquired from other known bone-seeking radionuclides. The biokinetic model provides a mathematical means of predicting the distribution, retention, and clearance of plutonium within the human body that may be used in deriving organ, tissue, and whole body dose. This work proposed a modification to the ICRP 67 systemic model for plutonium that incorporated the latest knowledge acquired from recent human injection studies with physiologically based improvements. In summary, the changes included a separation of the liver compartments, removed the intermediate soft tissue-to-bladder pathway, and added pathways from the blood compartment to both the cortical and trabecular bone volumes. The proposed model provided improved predictions for several bioassay indicators compared to the ICRP 67 model while also maintaining its basic structure. Additionally, the proposed model incorporated physiologically based improvements for the liver and skeleton and continued to ensure efficient coupling with intake biokinetic models.
Learning and improving in quality improvement collaboratives: which collaborative features do participants value most?

OBJECTIVE To understand participants' views on the relative helpfulness of various features of collaboratives, why each feature was helpful and which features the most successful participants viewed as most central to their success. DATA SOURCES Primary data collected from 53 teams in four 2004-2005 Institute for Healthcare Improvement (IHI) Breakthrough Series collaboratives; secondary data from IHI and demographic sources. STUDY DESIGN Cross-sectional analyses were conducted to assess participants' views of 12 features, and the relationship between their views and performance improvement. DATA COLLECTION METHODS Participants' views on features were obtained via self-administered surveys and semi-structured telephone interviews. Performance improvement data were obtained from IHI and demographic data from secondary sources. PRINCIPAL FINDINGS Participants viewed six features as most helpful for advancing their improvement efforts overall and knowledge acquisition in particular: collaborative faculty, solicitation of their staff's ideas, change package, Plan-Do-Study-Act cycles, Learning Session interactions, and collaborative extranet. These features also provided participants with motivation, social support, and project management skills. Features enabling interorganizational learning were rated higher by teams whose organizations improved significantly than by other teams. CONCLUSIONS Findings identify features of collaborative design and implementation that participants view as most helpful and highlight the importance of interorganizational features, at least for those organizations that most improve.
Menopausal status and factors affecting cessation of menses in the region of Bonn, Germany

Because of the high prevalence of hormone use and reproductive surgeries in Western women natural menopause is a less frequent condition. Our aim was to examine the influences of hormonal and other factors on timing of cessation of menses. We analysed population controls of a German case-control study on breast cancer risks. The sample comprised N=829 women without hysterectomy or bilateral oophorectomy. We estimated the risk for the occurrence of last menses by Cox proportional hazard modelling. For calculating hazard rate ratios (HRR) and 95% confidence intervals (CI) women with menstrual cycles up to one year before interview were censored at that age. Median age at cessation of menses was 50 years (inter-quartile range 47–53 years). A significant later cessation of menses resulted from oral contraceptive use (HRR 0.74, 95% CI 0.59–0.93 for up to 10 years), and hormone therapy use until last menses (HRR 0.57, 95% CI 0.47–0.70). Also, thyroidal medications were associated with a delayed cessation of menses (HRR 0.64, 95% CI 0.42–0.96 for more than 10 years of use). Smoking until at least two years before last menses and allergies revealed an earlier cessation of bleedings (HRR 1.50, 95% CI 1.22–1.83 and HRR 1.28, 95% CI 1.07–1.53 respectively). Natural menopause is difficult to determine. Factors affecting the ovaries or the endocrine system can modulate timing of menopause. Endocrine biomarkers should be additionally taken into account when defining menopausal status.
Implementation of a Portable HPGe for Field Contamination Assay

AbstractUsing MCNP to construct a detector model based initially on x-ray images of a portable high purity germanium (HPGe) detector followed by normalizing covering material values to also agree with check source responses, a validation of the model was attained. By calibrating the detector parameters using large count spectra, rigorous reproducibility is attained for high activity measurements but does not prevent deviations from normality in error distributions at the very low count events where spectral peaks are not always identifiable. The resulting model was created to allow operational assay of contamination over large areal distributions that could not otherwise be measured, such as the exhaust shaft at the Waste Isolation Pilot Plant (WIPP). Results indicate that contamination levels of activity in the exhaust shaft can be assayed to within a factor of 2. Detection limits are evaluated to be well below the contamination levels, which would constitute a legal environmental release if unfiltered ventilation of the underground facility were used.