Given a passage with a context and an answer, construct a question on the basis of the information present in the passage. Construct the question in such a way that (i) it is unambiguous, (ii) it is answerable from the passage, (iii) its answer is unique (iv) it answer uses text phrases from the passage. Avoid creating questions that (i) can't be answered correctly without actually understanding the passage and (ii) uses the same words or phrases given in the passage.

Example Input: Context: The aim of this study was to determine the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma.', 'The study included 1023 patients who underwent gastrectomy with lymphadenectomy for primary gastric carcinoma between January 1993 and December 1996. EM was defined as the presence of tumour cells in extramural soft tissue that was discontinuous with either the primary lesion or locoregional lymph nodes.', "EM was detected in 146 (14.3 per cent) of the 1023 patients and in 1060 (3.0 per cent) of the 35 811 nodules that were retrieved as 'lymph nodes' from adipose connective tissues. The incidence of EM was significantly higher in patients with tumours that were large (diameter 10 cm or more), infiltrative, deeply invading or undifferentiated and in those with lymph node, peritoneal or liver metastases, or lymphatic or vascular involvement. After curative operation overall survival was significantly worse for patients with EM than those without (P < 0.001). Multivariate analysis identified EM as an independent prognostic factor (hazard ratio 1.82 (95 per cent confidence interval 1.23 to 2.71); P = 0.003).
Answer: EM is an independent prognostic factor and should therefore be included in the tumour node metastasis (TNM) staging system.
Example Output: Is extranodal metastasis an indicator of poor prognosis in patients with gastric carcinoma?

Example Input: Context: Cytotechnologists and pathologists often perform onsite evaluations of thyroid fine-needle aspirations (FNAs) to provide immediate feedback regarding whether adequate material has been obtained for cytologic diagnosis. The current study was designed to determine whether onsite adequacy assessment results in a significant decrease in nondiagnostic specimens between ultrasound (US)-guided FNAs of the thyroid and those performed by palpation alone.', 'A search was performed to identify in-house thyroid FNAs performed between January 1, 2000 and December 31, 2003 that were obtained under US guidance or by palpation only. It was then recorded whether an onsite adequacy assessment was performed. The submitting physician and final diagnosis also were recorded for each case. Contingency tables were constructed and evaluated using chi-square analysis.', 'Of 1502 in-house thyroid FNAs included in the current study, 981 (65.3%) were performed under US guidance and 521 (34.7%) were performed with palpation alone. Onsite adequacy assessment of the aspirated material was performed in 323 cases (21.5%), whereas 1179 cases (78.5%) were performed without onsite evaluation. Of the 418 palpation-guided FNAs that were performed without adequacy assessment, 70 (16.7%) were reported to be nondiagnostic, whereas of the 103 palpation-guided FNAs with immediate evaluation, only 7 (6.8%) were determined to be inadequate for diagnosis. This difference was statistically significant (P < 0.025). Of 761 US-guided FNAs without immediate adequacy assessment, 54 (7.1%) were nondiagnostic, which was not statistically different from the nondiagnostic rate of 4.5% (10 of 220 cases) for US-guided FNAs with onsite evaluation. However, when these US-guided FNAs were divided further into 2 groups based on the experience of the radiologist performing the FNA, the nondiagnostic rate in the group of experienced radiologists was only 5.4% (or 32 of 592 US-guided FNAs), even though onsite evaluation was not performed. Among radiologists with less experience, adequacy assessment significantly reduced the nondiagnostic rate from 13.0% (22 of 169 FNAs without adequacy assessment) to 4.5% (10 of 220 FNAs with adequacy assessment) (P < 0.01).
Answer: The results of the current study demonstrate that onsite adequacy assessment of thyroid FNAs significantly reduces the number of nondiagnostic aspirates. However, the benefit of onsite evaluation, at least for US-guided FNAs, depends on the experience of the radiologist. In the current study, experienced radiologists with a relatively low nondiagnostic rate did not benefit from onsite adequacy assessment. This finding confirms the importance of experience in the performance of FNA, but suggests that onsite adequacy assessment may assist the less experienced operator.
Example Output: Is the value of onsite adequacy assessment of thyroid fine-needle aspirations a function of operator experience?

Example Input: Context: Continuity of care has traditionally been regarded as a core quality of general practice, but the long-term doctor-patient relationship has been put under pressure. In many places practices are expanding, with larger teams and more registered patients, thereby threatening the possibility of patients staying with their own general practitioner (GP). GPs often take it for granted that interpersonal continuity is valuable. However, little is known about how patient satisfaction is related to interpersonal continuity. The purpose of this study is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the GP, and in a comprehensive way to investigate how this is related to continuity of care.', "Qualitative study based on 22 interviews with patients from two practices in Denmark. A total of 12 patients saw a regular doctor and 10 saw an unfamiliar doctor. The patients were selected after an observed consultation and sampled purposefully according to reason for encounter, age and sex. Interpretative phenomenological analysis (IPA) was used to study how patients perceive meeting either a regular or an unfamiliar GP. The analysis explored the patients' perception of their interpersonal relationship with their GP, and interpreted the accounts by using social psychological theories.", "A long-term continuous relationship with the GP could be satisfactory, but it could also be the reverse. The same pattern was shown in case of an unfamiliar GP. Therefore, patient satisfaction and interpersonal continuity were not causally related. On the contrary, there was a general pattern of how the satisfactory and trustful doctor-patient relationship from the patients' point of view could be created, maintained or destroyed. A pattern where the process of recognition, by respecting and remembering, on the one hand created and maintained satisfaction while humiliation on the other hand destroyed satisfaction in the relationship.
Answer: It was not valuable to have a continuous relationship unless the GP recognized the patient. The social psychological concept of recognition had two different meanings and the GP had to do both, respect and remember the patient, in order to create and sustain the trustful relationship. The added value of interpersonal continuity had to be combined with recognition.
Example Output:
Does it 's all about recognition ! Qualitative study of the value of interpersonal continuity in general practice?