bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Effects of Indomethacin Prophylaxis in Extremely Low Birth Weight Infants
Authors: McGuire William , Fowlie Peter W. 
Published: August 2024

Abstract
The TIPP investigators assessed whether prophylactic indomethacin, used to reduce the incidence of PDA and severe IVH, reduced the risk of death or adverse neurodevelopmental outcomes in extremely low birth weight infants. This multicenter trial assigned 1202 infants, soon after birth, to receive indomethacin (0.1 mg/kg) or placebo intravenously once daily for 3 days. The primary outcome was a composite of death, cerebral palsy, cognitive delay, deafness, or blindness at 18 months’ post-term. This composite outcome was found to be similar in the intervention and placebo cohorts (47% versus 46%, respectively; odds ratio [OR] 1.1, 95% CI 0.8 to 1.4). Severe periventricular hemorrhage, but not other intracranial abnormalities seen on cerebral ultrasound, was lower in the indomethacin group (9% versus 13%; OR 0.6, 95% CI 0.4 to 0.9, p = 0.02).
Effects of Morphine Analgesia in Ventilated Preterm Neonates
Authors: Mitra Souvik 
Published: August 2024

Abstract
Morphine infusion for pain control in ventilated preterm neonates is postulated to reduce neurological injury. A large, multicenter, blinded randomized controlled trial (RCT), NEOPAIN investigated whether preemptive (prophylactic) morphine analgesia, as compared with placebo, reduced early neurological injury in 898 ventilated preterm neonates. There was no difference in the primary composite outcome of neonatal death, severe intraventricular hemorrhage (IVH), or periventricular leukomalacia (PVL) between placebo and morphine groups (26% versus 27%). Post-hoc secondary analysis evaluated differences between enrolled infants who received open-label morphine and those who did not. This revealed worse outcomes among infants receiving open-label morphine.
A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele
Authors: DeMauro Sara B. 
Published: August 2024

Abstract
The Management of Myelomeningocele Study (MOMS) trial compared prenatal versus postnatal repair of myelomeningocele, presenting evidence that expanded the range of fetal surgery beyond uniformly life-threatening conditions. The trial was stopped, after randomization of 183 women of a planned 200, for predefined efficacy measures at both 12-month and 30-month time points. Prenatal repair decreased the risk of death or need for cerebrospinal fluid shunt at 12 months (relative risk 0.70, 97.7% confidence interval 0.58 to 0.84, p &lt;0.001) and improved motor function at 30 months. On balance, women treated with prenatal surgery had higher rates of pregnancy complications. Thirteen percent of women in the prenatal surgery group and no women in the postnatal surgery group delivered before 30 weeks of gestation.
Levetiracetam Versus Phenobarbital for Neonatal Seizures
Authors: Johansson Stefan 
Published: August 2024

Abstract
Efficacy and safety are not established for commonly used drugs for neonatal seizure control. The NEOLEV2 trial randomized infants 36 to 44 weeks’ gestation with seizures of any etiology, to treatment with phenobarbital or levetiracetam. For inclusion in the intention-to-treat analyses, neurophysiologists were to confirm seizures before treatment and validate seizure control after treatment. The primary outcome, freedom from seizures for 24 hours, was reached in 24 of 30 infants (80%) in the phenobarbital group versus 15 of 53 infants (28%) in the levetiracetam group (relative risk 0.35, 95% confidence interval 0.22 to 0.56, p &lt;0.001). Side-effects such as hypotension and sedation were more common in the phenobarbital group, although risk estimates were not statistically significant in this small trial.
Substance Abuse in Healthcare Professionals
Authors: Sprintz Michael , McClain Vincent 
Published: August 2024

Abstract
The chapter provides an in-depth exploration of the complex and oft-neglected issue of substance use disorders (SUDs) within the healthcare workforce and demystifies common misconceptions surrounding SUDs, highlighting their neurobiological underpinnings and describing typical behaviors of healthcare professionals (HCPs) grappling with SUDs. Professional intervention can be life- and career-saving. Given the risks involved, it’s important to follow appropriate procedures when reporting and/or confirming suspicions of a colleague’s SUD. Using effective engagement strategies for confronting an individual suspected of having an active SUD are explored, including the potential risks and ethical considerations involved. Professionals Health Programs (PHPs) are vital resources for supportive monitoring of impaired HCPs and ongoing advocacy, while the controversial issue of returning to work post-treatment is also discussed, examining the necessary safety requirements, potential benefits of self-referring to a PHP, as well as the widespread and long-term success of PHPs helping HCPs return to work successfully. Offering a comprehensive and compassionate approach to a complex issue, this chapter serves as a valuable guide for healthcare professionals navigating the challenging landscape of SUDs within their ranks.
Addressing Patient Nonadherence
Authors: Adedeji Omowunmi , Ludi Daniel , Catalanotti Jillian S. 
Published: August 2024

Abstract
Poor adherence to medical treatment is common among patients in healthcare. This is a substantial barrier to effective care for patients and can lead to many adverse consequences, such as poor health outcomes, frivolous use of healthcare resources, and frustration among clinicians. Many factors lead to nonadherence among patients, such as financial constraints, fear of harm, mistrust of the healthcare system, and lack of health literacy. Clinicians need to understand and identify the underlying causes of nonadherence. By addressing these obstacles, both the clinician and patient can make changes to the treatment plan. This chapter examines reasons for nonadherence and strategies for caring for these patients. Motivational interviewing is a commonly used method to promote behavior change. The SIMPLE mnemonic (Simplify medication regimen, Impart knowledge, Modify patient beliefs, Patient and family communication, Leave the bias, Evaluate adherence) categorizes interventions for nonadherence and utilizes motivational interviewing principles. The “teach-back” method can be used to confirm understanding of their health information. Applying these communication techniques as well as others discussed in this chapter, the clinician will be better prepared to overcome adherence in more manageable ways.
Professional Pitfalls of the Electronic Health Record
Authors: Thomas James , Delgado Julia A. Gálvez 
Published: August 2024

Abstract
The American Recovery and Reinvestment Act and the Health Information Technology for Economic and Clinical Health (HITECH) Act defined the goals and established a roadmap for adoption and utilization of electronic health records (EHRs). Institutions and providers received financial incentives to adopt EHRs to offset the cost of implementation. The Institute of Medicine has outlined a list of core functionalities for EHRs. One of the central goals of EHRs was to increase patient access but widespread adoption of personal health record portals remains an elusive goal. In pediatric settings, breaches of confidentiality may occur when parents access their children’s health records. The use of EHRs does not eliminate the chance of medical errors, such as placing orders in the wrong record. Clinical decision support is an EHR feature that can lead to sustained practice change through recommendation of best practices. Implementation of clinical pathways may result in decreases in length of stay and improved outcomes. External and internal events may lead to system failure, and all institutions are required to have a back-up plan for system outages and downtime procedures. It is crucial that the documentation workflows are intuitive and designed to minimize redundancy to prevent physician frustration and burnout.
Social Media Sinkholes
Authors: Makar Katelyn G. , Vercler Christian J. 
Published: August 2024

Abstract
The birth of social media changed human interactions forever. Given its inherent ability to provide instantaneous connection, it has been applied extensively in the medical field to facilitate education, research collaboration, networking, career development, and even marketing and branding. While social media can be a powerful tool for physicians, it can also be a dangerous one. Physicians must understand the potential pitfalls of using social media, including breaches of patient confidentiality. The profession must be committed to higher standards than simply adhering to the Health Insurance Portability and Accountability Act (HIPAA). Physicians must carefully consider the appropriateness of content posted and the context in which it may be interpreted. Physicians must also maintain awareness of the physician–patient power differential and its impact on patients’ willingness to participate in social media engagement. Finally, it is critical for physicians to comprehend the unique risks of social media and fully disclose these risks to patients.
Conflicts of Interest and the Influence of Healthcare Companies
Authors: Keepers George A. , Stanley Sean 
Published: August 2024

Abstract
Conflicts of interest created by healthcare personnel involvement with the pharmaceutical and device manufacturing industry can adversely affect patient care by biasing research, distorting medical education, influencing prescribing practices, and shaping clinical guidelines. Companies have evolved multiple effective methods for creating influence in each of these areas. Despite research clearly demonstrating the impact of these practices, recommendations of the Institute of Medicine, and federal regulation, healthcare personnel continue to participate in industry-sponsored activities that will affect their decisions about patient care. Identifying events and practices that produce these conflicts of interest and learning to avoid and manage them is a critical skill for physicians, advance practice nurses, physician assistants, and others who determine the treatment that patients receive.
Improving Efficiency and Patient Safety While Reducing Cost Through a Quality Improvement Event
Authors: Liberman Justin S. , Weigel Wade A. 
Published: August 2024

Abstract
This chapter provides a real-life example of a quality improvement event from its inception to completion. It reviews how to identify a quality gap, assemble an interprofessional team, create a SMART aim statement, perform process analysis, perform cause analysis, select metrics, and navigate organizational change. The chapter provides examples of quality improvement methodologies such as Lean, Six Sigma, the Institute for Healthcare Improvement (IHI) Model for Improvement, and the Plan-do-Study-Act (PDSA) cycle. The chapter describes Lean Management System concepts such as Type 1 and Type 2 waste, value-added and non–value-added processes, mistake-proofing, and Taiichi Ohno’s seven wastes. It reviews examples of cause analysis, including Pareto charts, Five Why’s, and the fishbone diagram. It discusses three types of metrics used to understand the success of quality improvement projects: process metrics, outcome metrics, and balancing metrics. Finally, this chapter discusses how to transform a quality improvement project into organizational change and provides insight on how to sustain these changes in your organization.
Leadership Styles for Influencing Change in Healthcare Systems
Authors: Steckler Nicole A. , Angele Theard M. 
Published: August 2024

Abstract
Leadership in a health professions context refers to how individuals influence what happens next, using a combination of different approaches or styles depending on their own strengths and on the needs of the situation. This chapter offers the case of a new leader seeking to influence change in a clinical unit’s existing culture and climate to explore the following questions:
How is leadership defined in a health professions context? What leadership style would be most effective for an individual taking on a new responsibility in a new institution? What leadership styles promote learning and professional development? What leadership behaviors contribute to increasing/decreasing psychological safety among diverse members of a healthcare team?
How might a physician leader’s perceptions of a preferred leadership style differ if this leader experiences one or more social identities (e.g., race, gender, ethnicity, sexual orientation, nationality) historically marginalized in healthcare settings?
Leadership Competencies
Authors: Otsuki J. Alan , Hedges Jerris R. 
Published: August 2024

Abstract
Although many leadership competencies are required to manage a disaster, it is important that the Chief Medical Officer develop and use skills related to anticipatory planning. Effective anticipatory planning requires an appreciation of the interconnections between people, organizations, and infrastructure within and external to a healthcare delivery system. Effective leadership in a time of crisis requires communication of the situation, responsibilities, and initial response steps to team members. Disasters often impact the homes of those working in the medical center as well. Thus, the leader may need to consider personal and staff members’ family and property concerns as well. A leader’s greatest asset will be the ability to influence and inspire others while displaying high emotional intelligence, self-awareness, and prompt and effective communication. The ability to manage complexity and uncertainty as well as assess which hospital service areas are expected to be in immediate demand for high-acuity patients or triage is crucial. Good conflict management and media relations are also essential for the success of the leadership response to a disaster.
Approaching Conflicts Between Clinical Teams and Families
Authors: Olszewski Aleksandra , Patneaude Arika , Kett Jennifer 
Published: August 2024

Abstract
In medicine, it is common for patients and families to be labeled “difficult.” Those who receive this label have been shown to have worse outcomes, and this challenging clinical relationship is associated with distress for clinical teams. Factors associated with the labeling of patients and families as “difficult” include those related to patients and their families, those related to clinicians, and those related to the environment in which they are interacting. By understanding each of the factors that influence this problem, clinicians can better address conflicts by recognizing their own internal biases, seeking to understand family perspectives (including any unmet needs), and adjusting clinician and family expectations.
Prescribing for Friends and Family
Authors: Escalante Enrique , Smith Karen 
Published: August 2024

Abstract
It is extremely common for physicians to receive requests to provide informal advice or undocumented care to family members, friends, neighbors, and colleagues who are not their patients. While attitudes toward this practice have shifted over time, and it is much less common than before, the guidelines pertaining to prescribing to friends and family are not clear. This chapter provides the most important guiding documents in current practice, the questions that providers should use to assess whether prescribing is necessary and appropriate depending on the scenario, how providers might avoid an ethically dubious situation, and the practice requirements for communication and documentation if choosing to prescribe for family and friends.
End-of-Life Decision-Making
Authors: Lewis-Newby Mithya , Berkman Emily , Clark Jonna D. 
Published: August 2024

Abstract
A clinician sometimes is faced with requests from patients or families for treatments that the clinician perceives as potentially inappropriate in the setting of a poor prognosis. Members of the healthcare team may be concerned that the requested treatment will not benefit the patient and may be excessively burdensome or be a poor use of scarce medical resources. The term “medical futility” was often used in the past to describe these scenarios. A landmark 2015 policy statement provides the most current guidance for addressing these cases. When withdrawal of life-sustaining therapies is agreed upon by patients/surrogates and the medical team as the best course of action, several ethical principles are relevant. Withholding and withdrawing life-sustaining therapies, including artificial nutrition and hydration, are ethically and legally permissible actions. Providing medical relief of symptoms of suffering can be challenging, particularly in the critical care setting where patients are often tolerant to typical medications used at the end of life. The doctrine of double effect guides clinicians to administer medications to relieve suffering in an appropriate way. Euthanasia remains illegal in all states in the United States. Neuromuscular blockade agents should not be used at the end of life. Finally, deep respect and compassion for the patient’s and family’s unique progression and needs through the dying process are paramount to high-quality end-of-life care.
Organ Donation After Circulatory Determination of Death
Authors: Siegman Ingrid J. , Turner Helen N. 
Published: August 2024

Abstract
Organ donation after circulatory determination of death (DCDD) is an approach increasingly utilized to address the gap between the availability of and demand for lifesaving transplantable organs. Healthcare systems are required to have protocols in place to address ethical concerns that arise from identifying a patient who may be a potential organ donor through the organ recovery process. Ethical issues surrounding end-of-life decisions, including recognizing patient autonomy and self-determination to donate and managing potential conflicts of interest are essential aspects to consider. Addressing ethical considerations in the practice of DCDD is crucial to respect and honor the patient-donor, family, and members of the healthcare team as they navigate the process of organ donation.
How to Design and Moderate an Effective Problem-Based Learning Discussion
Authors: Lalwani Kirk 
Published: August 2024

Abstract
Problem-based learning (PBL) is a learner-driven instructional method based on active learning in small groups, with clinical or professional problems used as the trigger for learning. PBL has become an integral part of curricula in various undergraduate and professional disciplines, including medicine. While more resource-intensive than a traditional lecture, several educational and psychological theories support PBL. The benefits of PBL compared to traditional lectures include better retention, enhanced ability to utilize and apply new knowledge to solve real-world problems, and greater learner engagement that may lead to enhanced communication and team-based performance. Many professional society meetings invite PBL submissions for attendees. This chapter provides an overview of the components of PBL and practical tips on designing and moderating an effective PBL program at a professional society meeting or a longitudinal curriculum.
Curriculum Development
Authors: Edgar Laura , Guralnick Susan 
Published: August 2024

Abstract
Curriculum development for medical education is a complex process that can be achieved in a variety of ways. Two commonly used methods are the Six-Step Approach and Competency-Based Approach. Both provide a step-by-step roadmap for curriculum developers to follow. The Six-Step Approach is descriptive and allows for dynamic steps that can be performed in the order identified, any order, or multiple steps at a time. The competency-based approach is more prescriptive; it always starts with the identification of a competency after which all other steps must follow. Although these methods differ, several of the steps overlap. The two approaches can be used alone or in combination to achieve a curriculum development goal.
Virtual Teaching and Learning
Authors: De Gagne Jennie C. , Green Katrina 
Published: August 2024

Abstract
Virtual teaching and learning has been a viable option for education and professional development for many decades; however, this pedagogy differs from traditional classroom teaching. During the COVID-19 pandemic, much has been learned about virtual learning, and educators have gained insight into the skill sets, training, strategies, and tools that contribute to its successful implementation. As educators transition from traditional to virtual learning, sometimes doing so quickly in response to circumstances, a critical evaluation of their efforts is essential to identify areas that can be improved to increase learner success. This chapter helps educators incorporate new strategies into their virtual teaching and learning, apply best practices, explore new resources, and provide successful virtual teaching in health professions education.
Healthcare Simulation
Authors: Rubin Jamie E. , Seropian Michael 
Published: August 2024

Abstract
Simulation recreates aspects of real events for the purpose of analysis, learning, and training. It offers the opportunity to learn technical, cognitive, and behavioral skills and rehearse performance without risking harm to a real patient. Many considerations underpin successful implementation of simulation and a simulation program. Healthcare simulation is not just a manikin. Simulation consists of a spectrum of activities, ranging in intent and fidelity. This chapter provides an overview of the benefits and limitations of simulation as a teaching technique. Establishing psychological safety for participants is key and can be accomplished via a pre-brief conversation. Post-scenario feedback is critical to effective learning, usually as part of a structured debrief held at the conclusion of the scenario. Evaluation of both learners and the simulation program is critical for continued success.
Quality Improvement Science
Authors: Reynolds Staci 
Published: August 2024

Abstract
Providing high-quality patient care is the cornerstone of modern healthcare and is a major priority and area of focus among healthcare settings. This requires healthcare settings to continuously monitor quality metrics and improve care. Quality improvement science is an applied science that includes a formal approach to the analysis of practice performance and efforts to improve quality. Several models and frameworks are available to guide multidisciplinary teams through the quality improvement process. This chapter provides a case study example of the quality improvement process undertaken by a multidisciplinary team to improve quality of patient care at a large academic health system. This chapter provides an overview of the process, including how to prioritize quality improvement efforts, implement tests of change, measure and monitor progress over time, and sustain improvements made.
Medical Malpractice
Authors: Soelberg Cobin D. , Street Jeffrey R. 
Published: August 2024

Abstract
An expert witness is a critical component of the majority of medical malpractice cases. A witness is required to determine the prevailing community medical standard of care at issue in the case. Without an expert, one of the four pillars necessary to establish malpractice fails. The courts have established standards for expert testimony including scientific testing, verifiability, and acceptance by medical specialty societies. Medical specialty societies have professional oversight of member’s sworn testimony. While members can be sanctioned through medical boards or specialty societies for especially egregious testimony, the legal system strongly protects the expert witness. An expert works with either the plaintiff’s or defendant’s attorneys, reviewing the medical record and the facts of the case and providing an expert opinion on the medical care provided. An expert must be impartial, truthful and willing to have her testimony reviewed.