Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women.

OBJECTIVE: Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. METHODS: A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. RESULTS: The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved Incontinence Impact Questionnaire, Short Form, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in Urogenital Distress Inventory, Short Form scores. CONCLUSION: The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.

Enhancing Junior Doctors' Preparedness and Satisfaction in Trauma and Orthopaedics: A Quality Improvement Project With the Development of a Comprehensive Guidebook.

BACKGROUND: Junior doctors often feel underprepared for their trauma and orthopaedics (T&O) rotation due to limited exposure during medical school and inadequate support. This project aimed to enhance junior doctors' preparedness and satisfaction during their T&O rotation by developing a comprehensive guidebook that addresses key orthopaedic knowledge and logistical challenges. METHODS: A quality improvement project (QIP) was conducted at Ysbyty Gwynedd Hospital. Initial surveys identified factors contributing to poor experiences during the trauma and orthopaedics rotation, including limited knowledge of orthopaedic emergencies and a lack of useful reference resources. A guidebook was developed and refined through multiple plan-do-study-act (PDSA) cycles. The guidebook covered topics such as orthopaedic emergencies, common injuries, referral pathways, and hospital logistics, presented in an accessible flowchart format. RESULTS: The primary objective of achieving 75% satisfaction among junior doctors was successfully met, with satisfaction increasing from four (40%) to eight (80%) doctors in the most recent survey. Secondary outcomes included a marked improvement in the understanding of quality improvement projects, rising from three (30%) to eight (80%) doctors. Orthopaedic knowledge also saw a significant enhancement, increasing from four (40%) to nine (90%) doctors. Confidence in handling night on-call duties improved dramatically, with all 10 doctors (100%) reporting increased confidence, compared to four (40%) doctors initially. Additionally, seven doctors (70%) expressed a greater interest in pursuing a career in orthopaedic surgery. CONCLUSION:  The comprehensive guidebook significantly improved junior doctors' preparedness and satisfaction during their T&O rotation. While the guidebook is a valuable resource, ongoing mentorship and hands-on experience remain essential for long-term success. Replication of this project across other departments and hospitals is recommended to assess its broader applicability and impact.

Improving Professional Spiritual Care to Persons With Limited English Proficiency: The Cross-Language Chaplaincy Introduction Guidebook.

Hospitalized individuals in the United States with limited English proficiency (LEP) may experience complications when receiving hospital care. Grounded in the ethical principles of chaplaincy and motivated by the desire to address inequitable health service provision, we developed the Cross-Language Chaplaincy Introduction Guidebook. The Guidebook introduces chaplaincy in 20 different languages with the goal of improving chaplain accessibility. We report on the rigorous development of the Guidebook and how to integrate the resource clinically.

BEST PRACTICES IN MOLECULAR BREAST IMAGING: A GUIDE FOR TECHNOLOGISTS.

Molecular breast imaging (MBI) technologists are required to possess a combination of nuclear medicine skills and mammographic positioning techniques. Currently, no formal programs offer this type of hybrid technologist training. The purpose of this perspective is to provide a best practices guide for technologists performing MBI. Familiarity with best practices may aid in obtaining high-quality MBI examinations by decreasing the likelihood of image artifacts, positioning problems and other factors that contribute to false negative or false positive findings.

Written and Online Residency Guidebook to Improve Resident Efficiency and Knowledge of Best Patient Care Practices.

INTRODUCTION: Residents at most institutions change rotations every 2 to 4 weeks. It often takes significant time for residents to become acclimated to the different protocols, expectations, and environments of each unique rotation. As a result, residents often spend time searching for answers, time that could be spent in outside learning and direct patient care. The goal of this resource is to provide a novel guidebook that improves residents' efficiency and knowledge of best patient care practices. METHODS: The guidebook begins with an introductory chapter with key contact information that can be filled in for the user's institution, which is followed by 16 rotation-specific chapters. A rotation-based approach was chosen as it focuses the content on the most pertinent information. Thus, trainees can quickly read a chapter to cover the most pertinent content for their current rotation. As a surrogate marker for efficiency, noon-conference attendance logs were queried to assess improvement in on-time attendance after introduction of the guidebook. RESULTS: After introduction of the learning resources, on-time arrival to noon conference improved for all residents and interns. Guidebook survey results were universally favorable; however, around half of respondents stated that they used the guidebook once or less per rotation. DISCUSSION: Underutilization of these resources potentially contributed to the lack of a statistically significant improvement overall. Future directions should focus on augmenting the quality and utilization of the guidebook and then reevaluating if, once well adopted, there is a sustained benefit.

Physician-assisted suicide: reflections on Oregon's first case.

The authors analyze Oregon's first reported assisted suicide of Mrs. A as a real life application of the Oregon Death with Dignity Act. They critique the effectiveness of the Act's safeguards as illustrated by the case of Mrs. A. They point out that the Act does not require that physicians be adequately trained in palliative care in order to participate in assisted suicide. Most physicians do not have such training. Without it, they are not able to effectively present alternatives to patients requesting assisted suicide. Most physicians also lack the expertise to assess patients' decision-making capacity. Nor does the Act ensure that physicians will be in a position to assess coercion of patients' decisions. The Act requires physicians to report only minimal information about their cases, and there are no enforcement provisions to see that even this is done. Under the Act, a good faith standard rather than the more usual negligence standard immunizes physicians from civil or criminal liability even when they act negligently. The authors demonstrate that the Act protects physicians more than patients, and encourages secrecy. The authors conclude that secrecy will need to be replaced by openness to permit the kind of examination the practice of assisted suicide warrants.

Environmental risk analysis of hazardous material rail transportation.

An important aspect of railroad environmental risk management involves tank car transportation of hazardous materials. This paper describes a quantitative, environmental risk analysis of rail transportation of a group of light, non-aqueous-phase liquid (LNAPL) chemicals commonly transported by rail in North America. The Hazardous Materials Transportation Environmental Consequence Model (HMTECM) was used in conjunction with a geographic information system (GIS) analysis of environmental characteristics to develop probabilistic estimates of exposure to different spill scenarios along the North American rail network. The risk analysis incorporated the estimated clean-up cost developed using the HMTECM, route-specific probability distributions of soil type and depth to groundwater, annual traffic volume, railcar accident rate, and tank car safety features, to estimate the nationwide annual risk of transporting each product. The annual risk per car-mile (car-km) and per ton-mile (ton-km) was also calculated to enable comparison between chemicals and to provide information on the risk cost associated with shipments of these products. The analysis and the methodology provide a quantitative approach that will enable more effective management of the environmental risk of transporting hazardous materials.