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This paper describes the recommendations of a national panel on quality improvement in obstetrics to identify priorities for action among five areas of greatest medico-legal risk. Using previously conducted medico-legal data analyses and a systematic literature review, the panel reviewed existing data and developed recommendations for areas of focus in quality improvement in five obstetrical high-risk areas. The panel recommended clarification of definitions in some areas, identified needs for data collection and standardization of practices in others. The most promising interventions to improve care in the five areas were grouped into: standardized processes (such as protocols and communication tools), checklists, audit and feedback, mentoring and coaching, inter-professional communication, simulation and training, and shared decision making guides. This national panel of experts created 18 action-oriented recommendations focused on quality improvement to reduce medico-legal risk and improve the safety of care for Canadian mothers and babies., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: In randomized controlled trials (RCTs), outcome variables are often patient-reported outcomes measured with questionnaires. Ideally, all available item information is used for score construction, which requires an item response theory (IRT) measurement model. However, in practice, the classical test theory measurement model (sum scores) is mostly used, and differences between response patterns leading to the same sum score are ignored. The enhanced differentiation between scores with IRT enables more precise estimation of individual trajectories over time and group effects. The objective of this study was to show the advantages of using IRT scores instead of sum scores when analyzing RCTs., Study Design and Setting: Two studies are presented, a real-life RCT, and a simulation study. Both IRT and sum scores are used to measure the construct and are subsequently used as outcomes for effect calculation., Results: The bias in RCT results is conditional on the measurement model that was used to construct the scores. A bias in estimated trend of around one standard deviation was found when sum scores were used, where IRT showed negligible bias., Conclusion: Accurate statistical inferences are made from an RCT study when using IRT to estimate construct measurements. The use of sum scores leads to incorrect RCT results., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners., Methods: In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response)., Results: Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%)., Conclusions: Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

Aim: To develop an instrument measuring job resources among dentists, and to assess the relative importance of these resources and relate them to job satisfaction., Methods: 848 Dutch general dental practitioners (GDPs) received a questionnaire to monitor work experiences, including the Dentists' Experienced Job Resources Scale (DEJRS, 46 items, score range: 1 (not satisfying) to 5 (very satisfying), and the Dentist Job Satisfaction Scale (DJSS, 5 items, Cronbach's alpha = 0.85)., Results: A total of 497 (58.6%) dentists responded. Factor analysis (PCA) on the DEJRS resulted in 8 factors (Cronbach's alpha: 0.75 > alpha < 0.89), representing distinguishable categories of job resources. In rank order: Immediate Results / Aesthetics (M = 4.04, sd = 0.5); (Long-term) Patient Results (M = 4.03, sd = 0.6); Patient Care (M = 3.90, sd = 0.6); Craftmanship (M = 3.77, sd = 0.7); Idealism / Pride (M = 3.65, sd= 0.6); Entrepreneurship (M = 3.55, sd = 0.9); Material Benefits (M = 3.05, sd = 0.7); and Professional Contacts (M = 3.03, sd = 0.7). MANOVA indicated gender differences on: (Long-term) Patient Results (F(1,548) = 10.428, p = .001), and Patient Care (F(1,548) = 11.036, p < .001). Subscale correlations with the total DEJRS are: 0.57 > r < 0.88. All subscales show a positive correlation with the DJSS., Discussion: The DEJRS is a valuable and psychometrically sound instrument to monitor job resources as experienced by GDPs. Dentists report immediate results and aesthetics, and long-term results of working with patients to be the most rewarding aspects. All job resources showed a positive correlation with job satisfaction. The discussion includes conjecture that stimulating a greater awareness of job resources serves a major role in burnout prevention.

Objectives: The Stress Thermometer is an easily accessible Internet-based instrument for feedback on work stress and burnout. The aim of this paper is to describe the development of this instrument and to determine its applicability within the dental practice., Methods: The Stress Thermometer was made accessible to all members of the Dutch Dental Association, of which 77% of all Dutch dentists are members. Frequency of use was determined, and descriptive data was collected., Results: During an evaluation period of 5 months at least 12% of all possible respondents made use of the Stress Thermometer. Descriptive characteristics of the response group, as well as levels of burnout and work stress, corresponded with those found in the Dutch dentist population. However, some deviations were also present., Conclusions: Results indicate the applicability of the Stress Thermometer to a representative variety of dentists. Although the deviations found should not be ignored in future use, the Stress Thermometer was successful in reaching a population that is difficult to reach. It effectively calls attention to sensitive personal issues concerning work-related stress and burnout.

The effects on burnout of a career counseling program were measured among general dental practitioners. Out of a group of 171 dentists, identified with unfavorable scores on the Maslach Burnout Inventory - Dutch version (MBI-NL), nineteen chose to participate in the program. It consisted of individual counseling and group sessions, using cognitive and behavioral intervention techniques, over a 6-month period. One month after the last session, both program participants (N=17) and invited, but not participating, dentists (N=66) again filled in the MBI-NL. Comparison of participants' pre- and post-test scores showed significant statistical improvement on the MBI-NL scales emotional exhaustion (EE), and personal accomplishment (PA). Among the control group, a distinction was made between dentists who had self-initiated preventive measures (N=35) and those who had not (N=31). Self-prevention also appeared to have an effect on EE and PA. Among dentists who reported not to have undertaken preventive action, no change in burnout levels was found. With reservations, it can be concluded that the prevention program does have a positive effect on burnout scores among dentists, while different forms of self-initiated prevention activities also appeared to be effective.

Individual differences among dentists determine to a large degree what is experienced as work stress, but assessment of specific areas is necessary to be able to act preventively. The aim of this study was to develop an instrument to be used to monitor the experience of work stress in detail, to measure its levels, and to relate those levels to job (dis-) satisfaction. A questionnaire was developed, the Dentists' Experienced Work Stress Scale (DEWSS), covering widespread aspects of dental work, which was completed by 709 dentists, forming a highly representative sample of Dutch general dental practitioners. Factorial, correlational, and reliability analyses were conducted, after which seven areas of stress emerged: Work Pressure, Financial Aspects, Patient Contacts, Work Contents, Career Aspects, Team Aspects, and Professional and Private Life. Of these, Patient Contacts and Work Contents showed highest mean scores, as did the specific items: 'defaulters', 'governmental instructions', and 'unreasonable or demanding patients'. A strong inverse relationship was found between work stress, in particular lack of career perspective, and job satisfaction. The questionnaire is a valuable instrument to monitor pressure at work as felt by Dutch general dental practitioners. Patient contacts, work pressure, and career perspective clearly need preventive attention in the Dutch situation.

Dronabinol, delta-9-tetrahydrocannabinol in sesame oil, has been used for several years as an antiemetic for patients receiving cancer chemotherapy. In combination studies with prochlorperazine, enhancement of efficacy, as measured by duration of episodes of nausea and vomiting and by severity of nausea, has been found. The incidence of psychotropic effects from dronabinol appears to be decreased by concomitant administration of prochlorperazine. In open pilot studies, dronabinol caused weight gain in seven of ten patients with symptomatic HIV infection. In both HIV and cancer patients, dronabinol improved appetite at a dose which was well tolerated for chronic administration.