Tokugawa Japan ranks with ancient Athens as a society that not only tolerated, but celebrated, male homosexual behavior. Few scholars have seriously studied the subject, and until now none have ...satisfactorily explained the origins of the tradition or elucidated how its conventions reflected class structure and gender roles. Gary P. Leupp fills the gap with a dynamic examination of the origins and nature of the tradition. Based on a wealth of literary and historical documentation, this study places Tokugawa homosexuality in a global context, exploring its implications for contemporary debates on the historical construction of sexual desire.
Combing through popular fiction, law codes, religious works, medical treatises, biographical material, and artistic treatments, Leupp traces the origins of pre-Tokugawa homosexual traditions among monks and samurai, then describes the emergence of homosexual practices among commoners in Tokugawa cities. He argues that it was "nurture" rather than "nature" that accounted for such conspicuous male/male sexuality and that bisexuality was more prevalent than homosexuality. Detailed, thorough, and very readable, this study is the first in English or Japanese to address so comprehensively one of the most complex and intriguing aspects of Japanese history.
Anti-neoplastic agent spills are a known risk in the oncology setting despite the safeguards of personal protective equipment and closed system transfer devices. Spills result in the contamination of ...the environment and can be a source of exposure to healthcare workers. It is important to have training, education, and procedures in place regarding spill management. Nursing teams across the health system are trained on chemotherapy spill management and have access to the electronic copy of the procedural document in our enterprise-wide policy repository. Spills seldom occur and education specialist noted an opportunity for improvement in the post spill documentation. The purpose of this quality improvement was to create a chemotherapy spill template that would guide the nurse through all appropriate pieces of documentation. This would allow for complete documentation that includes all appropriate elements required in our standard operating procedure. A small team, including educators and EMR specialists met to draft the template. Contents of the template included location, size of spill, and disposition of waste. Additionally, the template incorporated the management of potential patient exposure. Details include documentation of exposure area of patients, appropriate notification of provider, pharmacy, supervisor and environmental services. Final documentation includes documentation of post clean up interventions such as continuation of treatment, stopping treatment or compounding of a new infusion bag by pharmacy. The template was implemented and education occurred across the health system with presentation of the template at meetings, creation of a job aid for caregivers, and posting of educational resource to an intranet based tool. Due to the nature of the template build, future reports can be created to determine the number of documented templates utilized on a monthly basis. Data can be analyzed to conclude whether there are additional educational needs for nursing teams.
Oncology Nursing Practice Pain is one of the most common symptoms that cancer patients experience during the course of their treatment. Pain assessment and documentation are essential to adequately ...manage pain, which can optimize patients' activities of daily living and quality of life. The purpose of this project was to identify gaps in pain assessment and documentation to improve the tools used to document pain and rates of completed pain assessments. We reviewed current documentation practices across the health system and determined that several different flowsheets and tools were being used to document pain assessment. There was little consistency among flowsheet fields and documentation standards. To address this, we collaborated with frontline nurses to develop a new centralized pain assessment flowsheet group that was incorporated into two flowsheets that are used system wide. Documented data populates on both flowsheets regardless of which is used. The new assessment tool includes discrete fields for pain score, description, location, and intervention(s). Discussions around this quality improvement project began in quarter one of 2021, and the revisions were finalized and education efforts were completed by quarter three of 2021. Pre-intervention data for quarters three and four of 2020 demonstrated that 35% of patients had a pain assessment documented during their treatment visits and 65% did not. Post-intervention data collected for calendar year 2021 showed that the percentage of documented assessments increased to 83%, while the percentage of missing or incomplete documentation decreased to 17%. The data demonstrates a 48% increase in documented pain assessments. Evaluation of documentation gaps and improvement of pain documentation tools aids nurses in assessing, addressing, and re-evaluating patients' pain. It is critical to involve frontline nurses in consensus building and planning interventions related to their practice. We believe that including infusion nurses from the planning stages contributed to the significant increase in documentation rates. Additionally, a multifaceted education effort was crucial to the success of this project. Tip sheets were developed and dispersed, documentation requirements were reviewed during daily huddles and were incorporated into orientation, and improvement in pain score documentation was added to daily management boards as a quality goal. This project demonstrates that empowering and including frontline staff to work on solutions that impact their practice can positively influence patient experience, quality of care, and advance nursing practice.
Abstract
Objective
The study sought to review recent literature regarding use of speech recognition (SR) technology for clinical documentation and to understand the impact of SR on document accuracy, ...provider efficiency, institutional cost, and more.
Materials and Methods
We searched 10 scientific and medical literature databases to find articles about clinician use of SR for documentation published between January 1, 1990, and October 15, 2018. We annotated included articles with their research topic(s), medical domain(s), and SR system(s) evaluated and analyzed the results.
Results
One hundred twenty-two articles were included. Forty-eight (39.3%) involved the radiology department exclusively and 10 (8.2%) involved emergency medicine; 10 (8.2%) mentioned multiple departments. Forty-eight (39.3%) articles studied productivity; 20 (16.4%) studied the effect of SR on documentation time, with mixed findings. Decreased turnaround time was reported in all 19 (15.6%) studies in which it was evaluated. Twenty-nine (23.8%) studies conducted error analyses, though various evaluation metrics were used. Reported percentage of documents with errors ranged from 4.8% to 71%; reported word error rates ranged from 7.4% to 38.7%. Seven (5.7%) studies assessed documentation-associated costs; 5 reported decreases and 2 reported increases. Many studies (44.3%) used products by Nuance Communications. Other vendors included IBM (9.0%) and Philips (6.6%); 7 (5.7%) used self-developed systems.
Conclusion
Despite widespread use of SR for clinical documentation, research on this topic remains largely heterogeneous, often using different evaluation metrics with mixed findings. Further, that SR-assisted documentation has become increasingly common in clinical settings beyond radiology warrants further investigation of its use and effectiveness in these settings.
•We propose a methodology to create technical documentation in AR.•The methodology is based on the use of STE and 2D symbols.•We applied successfully this methodology to two real case studies.•We ...validated the layout of information with a subjective user study.•Visual organization of information is clearer than iFixit and PDF manuals.
Augmented Reality (AR), is one of the most promising technology for technical manuals in the context of Industry 4.0. However, the implementation of AR documentation in industry is still challenging because specific standards and guidelines are missing. In this work, we propose a novel methodology for the conversion of existing “traditional” documentation, and for the authoring of new manuals in AR in compliance to Industry 4.0 principles. The methodology is based on the optimization of text usage with the ASD Simplified Technical English, the conversion of text instructions into 2D graphic symbols, and the structuring of the content through the combination of Darwin Information Typing Architecture (DITA) and Information Mapping (IM). We tested the proposed approach with a case study of a maintenance manual of hydraulic breakers. We validated it with a user test collecting subjective feedbacks of 22 users. The results of this experiment confirm that the manual obtained using our methodology is clearer than other templates.
Reading reference documentation is an important part of programming with application programming interfaces (APIs). Reference documentation complements the API by providing information not obvious ...from the API syntax. To improve the quality of reference documentation and the efficiency with which the relevant information it contains can be accessed, we must first understand its content. We report on a study of the nature and organization of knowledge contained in the reference documentation of the hundreds of APIs provided as a part of two major technology platforms: Java SDK 6 and .NET 4.0. Our study involved the development of a taxonomy of knowledge types based on grounded methods and independent empirical validation. Seventeen trained coders used the taxonomy to rate a total of 5,574 randomly sampled documentation units to assess the knowledge they contain. Our results provide a comprehensive perspective on the patterns of knowledge in API documentation: observations about the types of knowledge it contains and how this knowledge is distributed throughout the documentation. The taxonomy and patterns of knowledge we present in this paper can be used to help practitioners evaluate the content of their API documentation, better organize their documentation, and limit the amount of low-value content. They also provide a vocabulary that can help structure and facilitate discussions about the content of APIs.
Background: Childhood obesity is a public health crisis with rapidly increasing rates and long term consequences. Primary care pediatricians are essential to address this growing concern; however, ...data on clinician preparedness suggests that providers across all levels of training lack the sense of self-efficacy to discuss weight management with families. Methods: This is a prospective educational study on the management of patients with obesity in a pediatric resident clinic. Immersive, multidisciplinary education was presented across three sessions with interactive lectures and videos. Residents rated their self-efficacy on topics relating to the management of patients with obesity using a retrospective pre-post anchored response scale following the final educational session. On retrospective chart review, documentation of pertinent history regarding nutrition, activity, and sleep as well as management including counseling on healthy habits, creating personalized SMART goals, appropriate lab testing, referrals, and follow-up time frames were collected for patients ages 6-18 years with BMIs >95th percentile presenting for annual physicals. Documentation was compared 2 months pre- and post-education using a signed rank test with subgroup analysis based on year of training and total education sessions attended. Results: A total of 67 residents completed the pre-post self-efficacy survey (response rate 86%). Self-efficacy in all aspects of the management of patients with obesity was higher following the education (p < 0.0001). Chart review was performed for 63 residents including 237 instances prior to the education and compared to 172 instances following the final education session with overall improvement in resident documentation of pertinent history and management items following the education (p = 0.0262). Subgroup analysis showed greater improvement in history collection by residents in their 1st year compared to 2nd (p < 0.001) and 3rd years of training (p = 0.0037). Improvement in management documentation did not vary with subgroup analysis (p = 0.0357). Conclusions: A clinic-based educational intervention improved resident self-efficacy as well as documentation of history and management items for patients with obesity.
Landmark changes to documenting and coding for office or other outpatient evaluation and management (E/M) codes were implemented on January 1, 2021. To decrease clinicians' administrative burden, ...many documentation requirements were eliminated. In addition, major changes were made in how medical decision making and time spent on the date of the encounter are used to determine the level of service. On January 1, 2023, these changes were extended to inpatient and observation E/M services. The level of service in both inpatient and outpatient settings can now be selected based on the total time dedicated to the patient's care on the day of the encounter or the new method of medical decision making. This article discusses the optimal ways to document and code for inpatient hospital and observation encounters after January 1, 2023.
Source code summarization -- creating natural language descriptions of source code behavior -- is a rapidly-growing research topic with applications to automatic documentation generation, program ...comprehension, and software maintenance. Traditional techniques relied on heuristics and templates built manually by human experts. Recently, data-driven approaches based on neural machine translation have largely overtaken template-based systems. But nearly all of these techniques rely almost entirely on programs having good internal documentation; without clear identifier names, the models fail to create good summaries. In this paper, we present a neural model that combines words from code with code structure from an AST. Unlike previous approaches, our model processes each data source as a separate input, which allows the model to learn code structure independent of the text in code. This process helps our approach provide coherent summaries in many cases even when zero internal documentation is provided. We evaluate our technique with a dataset we created from 2.1m Java methods. We find improvement over two baseline techniques from SE literature and one from NLP literature.
PORTLAND, Ore. — Making admission decisions for students who lack documentation, or whose documentation is not standard, can be a challenge. For international students in particular, the disruption ...from COVID‐19 went beyond test scores, and events such as wars and natural disasters also lead to documentation irregularities. Some refugees don't even have access to their academic records.
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