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We explored the existence and application of standard operating procedures (SOPs) for pain management (PM) in German neonatal intensive care units (NICUs), and identified the factors associated with their application in practice. This study was part of the Safety4NICU project, a cross‐sectional survey conducted from 2015 to 2016. All 224 German NICUs were invited to participate, providing written consent from the head neonatologist and head nurse. We distributed questionnaires to the head neonatologist, the head nurse, and the NICU staff (physicians and nurses). We asked the head neonatologist whether written SOPs for PM existed, and we asked the staff whether these SOPs were applied in their daily routine. We received evaluable responses from 468 physicians and 1251 nurses from 76 NICUs. Of these 76 NICUs, the head neonatologists from 54 NICUs (71.1%) reported that written SOPs for PM exist. However, only 48.5% of the physicians and 53.7% of the nurses declared that these existing SOPs were also applied. We found various predictors for the existing SOPs as being applied, depending on the profession. For physicians, clinical training was important (OR: 2.482, p ≤ 0.05), while for nurses their working experience was a decisive predictor (OR: 1.265, p ≤ 0.05). For both, a high level of perceived cooperative norms between physicians and nurses increased the probability that SOPs for PM were applied, whereas a high bed turnover rate decreased that probability. According to the responses from head neonatologists, written SOPs for PM were common in German NICUs. However, if management strategies on pain existed, this did not mean that these were directly applied in the daily routine. Clinical training of the staff, the promotion of adequate interprofessional cooperation, as well as allowing time to deal with these SOPs might be all essential measures to strengthen the application. [ABSTRACT FROM AUTHOR]

The current level of environmental damage has become a global problem. Office buildings have many activities that require a lot of energy consumption, including water and electricity. They also produced a lot of waste which harms the environment. Overcoming this environmental problem requires cooperation from all elements of society, especially academics in universities who act as the scientific community. The Eco Campus/Eco-Office program is the solution that is applicable in overcoming problems in the campus's environment. This study aims to develop a design for implementing the Eco-Office at the Faculty of Engineering, Universitas Islam Bandung (UNISBA). The method used is a descriptive qualitative method using observations, in-depth interviews, and documentation studies. The results of this study were in the form of alternative and technical strategies. These alternative strategies included policy documents, standard operating procedures (SOP) for Eco-Office, and the formation of a special team to handle the Eco Office and routine outreach at the Faculty of Engineering, UNISBA. The technical strategies based on the existing conditions were energy efficiency (water and electricity), waste management, reducing the usage of papers, and maintaining office sanitation. [ABSTRACT FROM AUTHOR]

Objective: Uniform data collection is fundamental for multicentre clinical trials. We aim to determine the variability, between ALS trial centers, in the prevalence of unexpected or implausible improvements in the revised ALS functional rating scale (ALSFRS-R) score, and its associations with individual patient and item characteristics. Methods: We used data from two multicentre studies to estimate the prevalence of an unexpected increase or implausible improvement in the ALSFRS-R score, defined as an increase of 5 points or more between two consecutive, monthly visits. For each patient with a 5-point or more increase, we evaluated the individual contribution of each ALSFRS-R item. Results: Longitudinal ALSFRS-R scores, originating from 114 trial centers enrolling a total of 1,240 patients, were analyzed. A 5-point or more increase in ALSFRS-R total score was found in 151 (12.2%) patients, with prevalence per study center ranging from 0% to 83%. Bulbar onset, faster disease progression at enrollment, and a lower ALSFRS-R score at baseline were associated with a sudden 5-point or more increase in the ALSFRS-R total score. ALSFRS-R items 2 (saliva), 9 (stairs), 10 (dyspnea), and 11 (orthopnea) were the primary drivers when a 5-point or more increase occurred. Conclusions: Sudden 5-point or more increases in ALSFRS-R total scores between two consecutive visits are relatively common. These sudden increases were not found to occur with equal frequency in trial centers; which underscores the need for amending existing standard operating procedures toward a universal version and monitoring of data quality during the study, in multicentre research. [ABSTRACT FROM AUTHOR]

Background: Oxygen is one of the most commonly prescribed drugs across the globe. The ongoing Covid-19 pandemic has put enormous burden on hospital infrastructure and oxygen demand. There is lack of knowledge among healthcare workers regarding optimal utilization of oxygen delivery devices, target oxygen saturations and adequate oxygen prescription. A quality improvement project was designed to optimize the oxygen usage in wards. Methods: A core team comprising one each of consultant, senior resident, junior resident and nursing officer was formed. Fish bone analysis was done to find deficiencies in the existing system and strategy was planned to overcome these deficiencies. The key intervention included education and training of staff, Formulation of Standard Operating Procedures, use of lower target oxygen saturation and use of oxygen concentrators. Results: The project was carried out for a very short period of 5 days, and a total of 180,000 liters of oxygen was saved. The use of oxygen concentrators increased from zero to 9.5% and thus reducing the load on central oxygen supply. Conclusion: The proper training and sensitization of health care workers can help in saving oxygen, which further helps in saving precious human life. [ABSTRACT FROM AUTHOR]

Background: Oxygen is one of the most commonly prescribed drugs across the globe. The ongoing Covid-19 pandemic has put enormous burden on hospital infrastructure and oxygen demand. There is lack of knowledge among healthcare workers regarding optimal utilization of oxygen delivery devices, target oxygen saturations and adequate oxygen prescription. A quality improvement project was designed to optimize the oxygen usage in wards. Methods: A core team comprising one each of consultant, senior resident, junior resident and nursing officer was formed. Fish bone analysis was done to find deficiencies in the existing system and strategy was planned to overcome these deficiencies. The key intervention included education and training of staff, Formulation of Standard Operating Procedures, use of lower target oxygen saturation and use of oxygen concentrators. Results: The project was carried out for a very short period of 5 days, and a total of 180,000 liters of oxygen was saved. The use of oxygen concentrators increased from zero to 9.5% and thus reducing the load on central oxygen supply. Conclusion: The proper training and sensitization of health care workers can help in saving oxygen, which further helps in saving precious human life.

Introduction: The cyclical process of hazard identification, risk assessment, risk mitigation, and review is a key step in developing a biorisk management (BRM) system. This paper describes how this process was initiated in two laboratories in Pakistan using a unique model of blended learning. Methods: A training needs analysis showed that the staff had very little knowledge of BRM systems. A workshop using a unique blended model was conducted in which virtual and in-presence learning occurred simultaneously. This workshop aimed to train the participants by applying two key concepts from the World Health Organization Laboratory Biosafety Manual 4th edition: 1) the cyclical process of risk assessment and 2) mapping the core biorisk and establishing heightened control measures in the laboratories of the participants based on the risk assessment. All scenarios and examples used in the training were from the participants’ laboratory work processes. Results: Prior to this project, no risk assessment was conducted in these laboratories. After the workshop, a risk assessment was performed for six work processes. In addition, seven core requirements and three heightened control measures were mapped, a biorisk officer was appointed, and a biosafety committee was convened. Furthermore, a biorisk manual, a biological waste management plan, an occupational health center, and a system for audits and inspections are being developed. Discussion and conclusion: BRM training is not a one-time effort; it has to be strengthened to ensure the development and implementation of a comprehensive and sustainable BRM system. Training must be applicable to local settings and incremental, in a way that participants are not overloaded with information.

Standard operating procedures (SOPs) contain general instructions and principles to standardize care, to improve effective and safe healthcare. Developing new, or updating current, SOPs is, however, challenging in fields where high-level evidence is limited. Still, SOPs alone have been shown to result in less complications. In this narrative review, we describe the process of creating a consensus-based SOP that is pragmatic for clinical practice since it can be created regardless of the current level of evidence. Through live audience engagement platforms, a group of experts will be able to both anonymously respond to a created questionnaire, and (subsequently) discuss the results within the same meeting. This modified Digital Delphi method as described here can be used as a tool toward consensus-based healthcare. [ABSTRACT FROM AUTHOR]

Background: Each year there are 7.3 million emergencies for the German rescue service, trend rising and around 59% of the emergency patients are treated by paramedics only; however, most of the studies focus on physicians, while their practical skills at the scene are rarely necessary. Accordingly, the responsibility for the patient lies with the paramedics most of the time. Their duty is to execute life-saving measures, stabilize the patient for the transport and the regular documentation of the operation. Retrospectively, the emergencies can only be analyzed based on the emergency protocols, which are mostly paper-based and handwritten. That causes an increased effort in the evaluation, which makes studies for the whole country hardly feasible. As of now there are only few data on quality of healthcare and documentation by the paramedics. Both were analyzed in this survey based on the emergency protocols. Method: A retrospective analysis of emergency protocols from June to July 2018 took place in Aachen, a major German city. A specific feature of Aachen is a 24‑h available emergency physician via telemedicine. The quality of documentation and healthcare was analyzed by including standard operating procedures. Primary endpoints were the frequency of documentation, the achievement of complete documentation, the correct indications for a physician, the development of critical vital signs and the average on-scene time of the ambulance. Results: Overall, 1935 protocols were analyzed. A complete documentation was achieved in 1323 (68.4%) suspected diagnoses, 456 (23.6%) anamneses, 350 (18.1%) initial and 52 (2.7%) vital signs at handover. Based on the documentation, there were 531 cases (27%) of patients treated by paramedics only, even though a physician would have been indicated. Out of those patients 410 critical initial vital signs were documented of which 69 (16.8%) improved, while there was no documentation of vital signs at handover in 217 (52.9%). Also, there was a significantly prolonged on-scene time for patients with belated indications for an emergency physician with 15:02 min in comparison to 13:05 min for patients without indications. Conclusion: Deficient documentation was found in multiple cases and several important vital signs for a complete differential diagnosis were missing. Furthermore, a quarter of all patients might have benefited from an emergency physician as they were taken to hospital with no or insufficient treatment, despite standard operating procedures. From a forensic point of view there is an alarmingly incomplete documentation of vital signs at handover. The on-scene time in general was within the predetermined time frame, but can still be reduced in different scenarios. Overall, we recommend strict adherence to the standard operating procedures and algorithms, to remove unnecessary documentation and implement a structured quality assurance. Moreover, the quality of treatment might benefit from the rising number of more specialized paramedics and an increasing use of telemedicine. [ABSTRACT FROM AUTHOR]

Even in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons' step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The "One Fits All" principle enables single port placement irrespective of the pancreatic procedure, while the "Reversed 6-to-6 Approach" offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has emerged as a major health care problem during 2020. The risk of infection and transmission led to imposition of a severe lockdown by the government. The diversion of health care machinery towards the control of transmission, treatment of the infected individuals led to a compromise in delivery of care towards non-COVID ailments. This is truer in rural and unapproachable areas where the health facilities were already in jeopardy. Study Design: A prospective observational study was conducted from May 2020 to November 2020 at PGIMER satellite center, Sangrur. Methods: Standard operating procedures (SOP) were instituted for physical consultation during the COVID-19 pandemic at PGIMER satellite center, Sangrur, a branch of PGIMER, Chandigarh. These were approved by the committee constituted for this purpose. The effectiveness of these SOPs was reported as percentage of healthcare workers who contracted infection for non-COVID OPD. Results: A total of 9963 patients attended the Out Patient Department (OPD). Male to female ratio of the patients was 1.2:1. Maximum (6141) consultations were sought for general physician followed by ophthalmologist (1464). Majority of the consultation were for benign non-communicable disorders. Seventy patients who visited the OPD were referred for COVID-19 testing as they had symptoms of infection. A total of 5 (3.8%) incidents of COVID-19 infection were reported among the healthcare workers at the center. Conclusions: The SOPs proved effective in the delivery of physical care with low occupational hazard to the healthcare workers (HCW). [ABSTRACT FROM AUTHOR]

Background: Different factors affect the success of standard operational procedures (SOPs). This study was conducted to explore the viewpoints of employees of Tehran Oil Refining Company about factors affecting the usability of SOPs. Methods: This qualitative study was a conventional content analysis research conducted on the oil refining company employers 2020, using the semi-structured interviews. The data were analyzed by content analysis method using MAXQDA software. Results: The results showed that the employees had a positive perception toward the standard operating procedures and most of them used these procedures to improve work performance and reduce accidents. Also, from the viewpoint of the employees, organizational factors (desirable organizational culture, continuous supervision and evaluation and assurance of accurate implementation of instructions, and continuous personnel training), individual factors (positive perception of the personnel about the organization goals, rules obedience of the personnel, positive experiences of personnel from the implementation of instructions in the past), and environmental factors (environmental dynamics and their related SOP dynamics, desirable but formal relationships of managers and supervisors with personnel as well as optimal and standard work schedule) had a positive effect on the applicability of these procedures. Conclusion: The findings of this study showed that the employees, consider standard operating procedures of organizational, individual, and environmental factors effective in using standard operating instructions. Therefore, to increase the applicability of these procedures, the employees should consider their opinions.

Purpose. The aim of the article is to explain how the Italian response capacities for the safeguarding of cultural heritage at risk of disaster has been enhanced over the past twenty-five years and how it has contributed to raising the awareness of this issue at international level. Approach/methodology. For this purpose, the main steps made in the last decades by Italy in including the protection of cultural heritage among other emergency issues are described below. In fact, Italy has made many efforts in the past decades to improve the emergency management of cultural heritage, paying particular attention to preparedness, prevention and response actions. Since the end of the past century, dedicated training courses have been organized at all levels as well as local, national and international exercises with specific scenarios dedicated to the protection of cultural heritage at risk of disaster in order to test specific procedures needed to ensure this type of response. In the meantime, the drafting of standard operating procedures specifically addressing the protection of vulnerable cultural heritage emerged as a result of a keen collaboration between the Italian Ministry of Culture (Italian acronym MiC) and the National Civil Protection Department (Italian acronym DPC). Findings. In this process of constant evolution of operational and technical capacities aimed at reducing the risk of cultural heritage disasters, the combination of past experience and acquired competences of Italy, France, Spain, Turkey, ICCROM and Fondazione Villa Montesca has prompted the launch of the PROCULTHER project, co-funded by the Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO). Value. The project aims to support and complement the efforts made by the European Union to strengthen cooperation between the EU Member States and Participating States in this field. In this sense, by pooling together European civil protection capacities and capabilities and providing for common standards enabling certified and well-equipped teams to work interchangeably when a disaster strikes, the Union Civil Protection Mechanism (UCPM), is an essential and effective system aimed at allowing a stronger and more coherent collective response. Under this framework, the project is promoting, for the first time, the development of a common European methodology, tools and capacities in order to include the protection of cultural heritage in the disaster risk management cycle and to ensure structured collaboration among cultural heritage and civil protection stakeholders at local, national and European level.

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; n = 103, 42% HIC and n = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00–0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07–0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% (n = 90); HIC: 43% (n= 44) vs. LMIC: 32% (n = 46), p = 0.56. Amongst the IHT SOP/HPs reviewed (n = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT.

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

Coastal cities are vulnerable to typhoon disasters due to their unique geographical location. Although significant progress has been made in the safety early warning system for construction sites, there are few studies on site safety management under typhoon disasters. Moreover, traditional manual methods of on-site emergency management are lagging behind and rigid, making it difficult to respond quickly to safety inspections manually. This study aims to automatically identify safety hazards and provide effective response measures during typhoon warnings, ultimately enhancing the safety of construction sites. Therefore, based on the MATLAB platform, this study developed a rapid safety inspection system (RSS-Typh) for the construction site during the typhoon warning period. In addition, the standard operating procedures (SOP) related to the system are formulated to assist the comprehensive safety inspection of the site before the typhoon and improve the inspection efficiency. The specific operation can be divided into three steps: 1.Using a combination of drones and handheld laser scanners to complete the complete construction site data acquisition in less than 2 h, and complete the modeling and refinement of the point cloud model in 5 h; 2.Using the developed hidden danger detection algorithm based on automatic point cloud to effectively identify the deformation-related hidden dangers at the construction site; 3.Use the designed automatic query security countermeasure GUI system to make rapid rectification. This study assists site managers in swiftly implementing effective safety management on construction sites, elevating the safety level of the site before typhoon. Furthermore, it serves to advance the automation of safety management in construction sites, promoting further developments in this field. [ABSTRACT FROM AUTHOR]

Background: In German emergency rescue services, inhalation treatment is routinely carried out by qualified health personnel. Standard operating procedures (SOP) for nebulization are neither uniform throughout Germany nor available in all federal states. Standardized recommendations with respect to which nebulizer type should be used are missing. The aerosol output as well as the drug deposition rates of jet and mesh nebulizers, however, differ considerably. Mesh devices can achieve a threefold higher lung deposition. Their use in emergency departments has also been shown to be associated with a better patient outcome when compared to jet nebulizers.Objective: This survey was designed to evaluate the type of nebulizer used in the south German rescue services. Special attention was paid to the influence of existing SOP on the decision to perform nebulization during emergency treatment.Material and Methods: A total of 4800 emergency paramedics working in Baden-Württemberg, Bavaria and Rhineland-Palatinate received a questionnaire with a total of 17 questions on the implementation of drug nebulization in the daily practice.Results: Despite the existence of more efficient nebulizer types, the jet nebulizer was by far the most frequently used nebulizer in the south German rescue services. The deposition rates of both the jet and mesh nebulizers were considerably overestimated by most respondents; however, 77.5% of all respondents could not give any information about the deposition rates of the mesh nebulizer. Only two thirds of all respondents carried out nebulization treatment on the basis of SOP. The implementation of SOP, however, was pivotal to the application of nebulization during emergencies. If SOP were in place,76.9% of the responders used aerosol treatment compared to 23.1% when there were none. The perceived safety when using nebulization during emergencies was also significantly higher (p = 0.013) when SOP were implemented.Conclusion: The exclusive use of mesh nebulizers could standardize the treatment of emergency patients in the south German rescue services. The use of mesh devices might possibly improve patient outcomes, even if clinical studies are still lacking. Nebulizer treatment differs between the federal states. A comprehensive implementation of SOP for nebulization treatment might support this process and could increase the application frequency and the perceived safety of nebulization during emergencies. A better training of paramedic personnel could improve the knowledge of aerosols as a treatment option for emergency patients and help to classify the advantages and disadvantages of the different aerosol generators available. [ABSTRACT FROM AUTHOR]

The Louisiana commercial shrimp fishery has faced numerous challenges, and the number of fishermen is declining at an alarming rate. The opportunity may exist to add value to the industry by creating a superior product through optimal operating procedures. Post-harvest processes of plate freezing were analyzed to develop a high-quality shrimp product capable of fostering economic growth for fishermen. Sulfite-free melanosis prevention testing used 4-hexylresorcinol treatments in combination with vacuum-packing and modified atmosphere packing to delay the onset of black spot. The physical and chemical properties of plate frozen shrimp were analyzed from collaborating fishermen. Results found 4-hexylresorcinol products successfully inhibited black spot development for up to 10 days. Vacuum-packing and modified atmosphere packing did not have significant effects on melanosis inhibition. The use of plate freezers both onboard and at docks has the potential to improve shrimp quality, as well as advance the economic stability of the industry. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the implementation of standard operating procedures (SOP) in different ophthalmic settings of Pakistan during Covid 19. Study Design: Cross sectional online survey. Place and Duration of Study: Baqai Medical University & Karachi Medical and Dental College, from 11th to 25th January 2021. Methods: This online survey included doctors working as consultants, medical officers and trainees in ophthalmology setups. A self-designed questionnaire on Google forms was sent online to see the implementation of standard operating procedures during COVID 19. Results: A total of 400 participants were selected by snowball sampling technique. A response rate was 105 (26.5%). Females were 66 (62.86%). Among all participants, 36.19% responded that they always screened patients for COVID 19 at reception. Doctors who always wore masks were 96.19%. Out of those who responded, 16.19% and 11.43% always wore protective goggles and disposable gowns respectively. Only 55.24% practiced hand sanitization, 18.10% washed hands with soap and 30.48% cleaned slit lamps after seeing each patient. Doctors who always asked for PCR before ocular surgery under general anesthesia were 65 (61.90%) and for local anesthesia were 36 (34.29%). Direct Ophthalmoscopy, tonometry, and gonioscopy were performed when necessary by 56.19%, 80.00%, 80.00% of doctors respectively. Only 69.5% were satisfied with precautionary measures. Conclusion: Clinic management needs improvement in implementing SOPs among patients in an eye OPD. Fifty percent of the ophthalmologists received PPE by their administration. Only 69.5% doctors were satisfied with precautionary measures. [ABSTRACT FROM AUTHOR]

One of the tasks of the government is fulfilling community rights by providing services. Services provided should follow existing laws and regulations; fast, reliable, and appropriate services are the main foundation for fulfilling community rights. Service performance can be measured using a theory proposed by Dwiyanto; the theory presents five indicators: productivity, service quality, responsiveness, responsibility, and accountability. Our study employed a qualitative descriptive method and would provide a systematic, factual, and accurate description of the object under study. We described public services from the point of view of service performance and factors supporting and inhibiting the performance of bureaucratic services. Our finding showed that public service performance had no standard operating procedure, resulting in time uncertainty for the services provided. There was also a problem related to the low ability of human resources, resulting in constraints on responsiveness. However, public employees showed good accountability and responsibility in providing services. Thus, it is necessary t [ABSTRACT FROM AUTHOR]

Background: The impact of the pandemic on medical record health service procedures has induced significant changes. The duplication of Covid-19 patient numbers in the patient medical record unit is an important concern. This study aims to analyze the legal aspects of managing medical record services during the Covid-19 pandemic in hospitals. Methods: This type of research is descriptive and quantitative with a cross-sectional approach. The key informants are 15 registration and medical record unit officers, using online interview techniques, employed in three hospitals in Semarang with a focus on group discussions. The object of research includes the management of medical records and service standards for Covid-19 patients as regulations in the medical record unit of the Semarang city general hospital. Results: Policies and standards for medical record services for Covid-19 patients, have not been adjusted to the provisions based on Circular Letter Number HM.01.01/001/III/2020 concerning procedures for work in situations of the Covid-19 outbreak. The medical record service for Covid-19 patients still applies paper-based or semi-electronic medical records so that errors can occur. This can cause legal problems for hospitals; therefore, medical record service standards must meet legal aspects as legal evidence that can protect the interests of various parties. Conclusions: It is necessary to manage a medical resume form design that is better, complete, electronical, and in accordance with legal aspects. Conflicts of interest: None declared. Authors’ contributions: This research was conducted in collaboration of all the authors. The authors of the RAS designed the study. Authors RAS, S, MS, ASW, BGV, ENR, NW and SHN did the sampling and wrote the first draft. Authors S, SI and RAS authors wrote the protocol and administered the study analysis. The RAS authors and SI authors managed the literature search. All authors read and approved the final manuscript. Data Availability: All relevant data has been registered with supporting file information. Ethical Approval: According to international standards or research standards in the Republic of Indonesia, written ethical consent has been collected and kept by the author. This research proposal has passed the ethical review from the Health Research Ethics Commission (KEPK) Faculty of Health, Dian Nuswantoro University Semarang on May 4, 2021 with an Ethical Approval Certificate issued with Number 024/EA/KEPK-Fkes-UDINUS/V/2021. Acknowledgements: The authors are grateful for their support to the Leadership Gondosuwarno General Hospital Ungaran, Ken Saras Hospital Bawen, the Permata Medika General Hospital Semarang, and the Dean of Faculty of Health, Dian Nuswantoro University, Semarang Indonesia.

Medical adverse events (AEs) indicate that medical intervention or prolonged hospitalization causes harm and disability to patients. In June 2017, a nurse in the unit of this study performed a far-infrared (FIR) therapy causing an accidental second-degree burn to the patient's right knee that needs wound debridement. Thus, a special group was set up to roll out the Perception Survey Questionnaire and the FIR checklist. The result showed that nurses have 62.5% and 67.6% correct recognition and operating rates, respectively. It was confirmed that the problem of accidentally causing the burn to the patient was due to the lack of knowledge with the familiar operating procedures and incomplete education and training (e.g., setting up standardized medical orders and auxiliary tools). Formulating standard operating procedures for FIR, completing education and training, designing irradiation safety posture maps, setting standardized medical orders, nursing records, and making use of far-infrared instrument teaching e-books are the corresponding countermeasures used. After the procedures, the post-test showed that the nurses have 98.7% and 97.5% correct recognition and operating rate, respectively. Consequently, the above interventions could effectively reduce medical AEs and improve the quality and safety of nursing care. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial halt of all elective surgical and medical procedures, more so in the practice of esthetic surgery and medicine, globally. As practices are trying to open up, the when, how, and what services can be scheduled again are the questions which arise in front of all service providers. Stringent infection control measures are the need of the hour in response to the current continuing COVID-19 pandemic. In esthetic clinics, guidelines for infection control measures as well as protocols for performing procedures are of particular importance for their safe and smooth functioning. Methods: A Medline/PubMed search was conducted for any and all possible publications on esthetic guidelines for safe functioning during the COVID pandemic. Advisories by the governments of the day, the World Health Organization, as well as those issued by various national and international esthetic societies were also taken into consideration. A set of protocols and preferred practice guidelines were drafted to allow functioning of the esthetic clinics as well as protect the doctors, clinic staff, and patients from the SARS-CoV-2 infection. Results: “Standard operating procedure (SOP)” guidelines for esthetic clinics were drafted and put into place in our Aesthetic Clinic at Indraprastha Apollo Hospital after going through all possible recommendations for scheduling patients, screening at entry, declaration and esthetic consultations, and for safety precautions about the different procedures and later categorized into low risk, moderate risk, and high risk based on the possibility of the transmission of SARS-CoV-2 virus from a possible infected patient to the treating physician or therapist, and the other way around. Conclusions: The SOP provides sound infection control measures for esthetic practices. There are guidelines regarding safety measures and use of personal protective equipment during scheduling, distancing, and risk-wise categorization, and also what procedures are permitted. These may vary from country to country, but local and national guidelines should be incorporated and followed to prevent the COVID-19 infection in esthetic clinics.

Abstract We have entered the post-antibiotic era. Phage therapy has recently been given renewed attention because bacteriophages are easily available and can kill bacteria. Many reports have demonstrated successful phage treatment of bacterial infection, whereas some studies have shown that phage therapy is not as effective as expected. In general, establishment of a standard operating procedure will ensure the success of phage therapy. In this paper, the whole operating procedure for phage therapy in clinical practice is explored and analyzed to comprehensively understand the success of using phage for the treatment of bacterial infectious disease in the future. The procedure includes the following: enrollment of patients for phage therapy; establishment of phage libraries; pathogenic bacterial isolation and identification; screening for effective phages against pathogenic bacteria; phage formulation preparation; phage preparation administration strategy and route; monitoring the efficacy of phage therapy; and detection of the emergence of phage-resistant strains. Finally, we outline the whole standard operating procedure for phage therapy in clinical practice. It is believed that phage therapy will be used successfully, especially in personalized medicine for the treatment of bacterial infectious diseases. Hopefully, this procedure will provide support for the entry of phage therapy into the clinic as soon as possible.

Social referents provide information that aid in farmer decision making. Some social referents, such as veterinarians, have been well studied in the context of dairy farms, but others have not and the role of social referents may change across management practices. This study aimed to understand (1) who farmers consult when making management decisions across different animal care practices and (2) what characteristics of these social referents influence farmer decision making. Secondary thematic analysis was used on two qualitative datasets with dairy farmers from the lower Fraser Valley region of British Columbia, Canada. The two datasets included non-naturalistic data (i.e. interviews, participatory discussion groups) investigating two dairy farm management practices (calf care and transition period management). Analysis revealed four themes: (1) who farmers consult when making management decisions across practices and the role of these social referents, (2) personal and professional characteristics, and the diversity of opinions of social referents, (3) actions of social referents, and (4) the strength of the relationship between the social referent and farmer. Similarities were found across practices regarding the personal and professional characteristics of social referents, even though the role of these referents varied across contexts. Farmers valued diverse opinions and actions that social referents could provide, such as the provision of resources, recommendations, and interpretation of farm data. We recommend future research focused on strengthening the relationship between farmers and social referents.

Calf loss continues to be a considerable problem on German dairy farms. Untrained personnel or the lack of best practice routines are potential reasons. Standard operating procedures (SOPs) may increase process consistency and can improve animal health and animal welfare. We developed SOPs for 8 important tasks in calf care and provided them online to interested dairy farmers and their employees. Five questionnaires were embedded to collect data on demographics, use, perception, and feasibility of SOPs. Main objectives of the study were to investigate 1) if there is a gap between the existence of SOPs and the wish for SOPs, 2) if participants (n = 301) consider ready-made SOPs as feasible for their farm and 3) suitable to train new personnel, and 4) if they state their confidence in task execution higher after the courses. We experienced a strong discrepancy between the existence (13.1%) and the wish for SOPs (69.4%). Most the participants rated ready-made SOPs as feasible for their farm (66.5%). Eighty-five percent fully agreed or agreed to the statement that SOPs are a suitable tool for training new employees. Interestingly, 64.2% of employees mentioned, that they wanted to be involved in the creation of SOPs specific to their farm. The SOP based e-learning courses increased the confidence in performing tasks in calf care, especially concerning the tasks which were less often performed tasks such as tube feeding, emergency care and testing of colostrum quality., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Up to the present day, studies on the therapeutic properties of camel (Camelus spp.) urine and the detailed characterization of its metabolomic profile are scarce and often unrelated. Information on inter individual variability is noticeably limited, and there is a wide divergence across studies regarding the methods for sample storage, pre-processing, and extract derivatization for metabolomic analysis. Additionally, medium osmolarity is not experimentally adjusted prior to bioactivity assays. In this scenario, the methodological standardization and interdisciplinary approach of such processes will strengthen the interpretation, repeatability, and replicability of the empirical results on the compounds with bioactive properties present in camel urine. Furthermore, sample enlargement would also permit the evaluation of camel urine’s intra- and interindividual variability in terms of chemical composition, bioactive effects, and efficacy, while it may also permit researchers to discriminate potential animal-intrinsic and extrinsic conditioning factors. Altogether, the results would help to evaluate the role of camel urine as a natural source for the identification and extraction of specific novel bioactive substances that may deserve isolated chemical and pharmacognostic investigations through preclinical tests to determine their biological activity and the suitability of their safety profile for their potential inclusion in therapeutic formulas for improving human and animal health.

The current cybersecurity landscape is conducive to the enhancement of the traditional cyber-exercising paradigm and instruments. Considering the complex nature of cyberattacks and their cascading impact, moving away from purely technical or entirely decision-making exercises is becoming paramount for realistic exercising of emergency response. Complex cyber-hybrid scenarios, exercising effective collaboration at the technical, operational, and higher decision-making levels, are increasingly employed to prepare for the emerging hybrid threats. Such scenarios simulate seemingly independent incidents in different locations, businesses, or systems that may quickly escalate to a sectoral or a national crisis. Unfortunately, such diverse scenarios often remain inaccessible due to the lack of proper simulation infrastructure and expertise to adapt them to various contexts. The current contribution presents the authors' experience in designing a Composite Cyber Range, following a Systems-of-Systems approach for the dynamic activation or incorporation of playgrounds and on-the-run integration of custom-made emulation and overlay ranges to support an "exercise-as-a-service" model for the provision of adequate and accessible cyber-hybrid mechanisms for crisis response training and preparation. [ABSTRACT FROM AUTHOR]

BackgroundAn international Delphi panel has defined a harmonized protocol (HarP) for the manual segmentation of the hippocampus on MR. The aim of this study is to study the concurrent validity of the HarP toward local protocols, and its major sources of variance.MethodsFourteen tracers segmented 10 Alzheimer's Disease Neuroimaging Initiative (ADNI) cases scanned at 1.5 T and 3T following local protocols, qualified for segmentation based on the HarP through a standard web-platform and resegmented following the HarP. The five most accurate tracers followed the HarP to segment 15 ADNI cases acquired at three time points on both 1.5 T and 3T.ResultsThe agreement among tracers was relatively low with the local protocols (absolute left/right ICC 0.44/0.43) and much higher with the HarP (absolute left/right ICC 0.88/0.89). On the larger set of 15 cases, the HarP agreement within (left/right ICC range: 0.94/0.95 to 0.99/0.99) and among tracers (left/right ICC range: 0.89/0.90) was very high. The volume variance due to different tracers was 0.9% of the total, comparing favorably to variance due to scanner manufacturer (1.2), atrophy rates (3.5), hemispheric asymmetry (3.7), field strength (4.4), and significantly smaller than the variance due to atrophy (33.5%, P < .001), and physiological variability (49.2%, P < .001).ConclusionsThe HarP has high measurement stability compared with local segmentation protocols, and good reproducibility within and among human tracers. Hippocampi segmented with the HarP can be used as a reference for the qualification of human tracers and automated segmentation algorithms.

Introduction: Metabolomics applications to the aquaculture research are increasing steadily. The use of standardized proton nuclear magnetic resonance (1H NMR) spectroscopy can provide the aquaculture industry with an unbiased, reproducible, and high-throughput screening tool, which can help to diagnose nutritional and disease-related metabolic disorders in farmed fish. Objective: Standard operating procedures developed for analysing (human) plasma by 1H NMR were applied to fingerprint the metabolome in plasma samples collected from Atlantic salmon. The aim was to explore the metabolome of salmon plasma in relation to growth stage and sampling site. Methods: A total of 72 salmon were collected from three aquaculture sites in Norway (Lat. 65, 67, and 70 °N) and over two sampling events (December 2017 and November 2018). Plasma drawn from each salmon was measured by 1H NMR and metabolites were quantified using the SigMa software. The NMR data was analysed by principal component analysis (PCA) and ANOVA-simultaneous component analysis (ASCA). Results: Important metabolic differences were evidenced, with adult salmon having a much higher content of very low-density lipoproteins and cholesterol in their plasma, while smolts displayed significantly higher levels of propylene glycol. Overall, 24% of the metabolite variation was due to the growth stage, whereas 12% of the metabolite variation was related to the aquaculture site and practice (p < 0.001). Conclusion: This study provides a baseline investigation of the plasma metabolome of the Atlantic salmon and demonstrates how 1H NMR metabolomics can be used in future investigations for comparing aquaculture practices and their influence on the fish metabolome. [ABSTRACT FROM AUTHOR]

Background: Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion: The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged. [ABSTRACT FROM AUTHOR]

The medically safe and high-quality food has an overwhelming impact on competitiveness in the hospitality market. Demands for safe and high-quality products have led to defining the SOP (standard operating procedures), that is, a set of directions required for creating a good hygienic and production practice, which also refers to the necessary measurements concerning critical points in production - preparation of dishes. In order to see the quality of operations in the hospitality market, the existence of the SOP is examined, during the food reception, storage and preparation in restaurant kitchens. The aim of the paper is to show to what extent the management and employees in hospitality facilities in Novi Sad are acquainted with the significance of the SOP for successful business operations of a hospitality facility, as well as to examine the extent of its application.

Introduction: Since 2008, specialized chest pain units (CPUs) were implemented across Germany ensuring structured diagnostics in acute chest pain. This study aims to analyze the management of pulmonary embolism (PE) patients in such certified CPUs. Methods: Data were retrieved from 13,902 patients enrolled in the German CPU registry and analyzed for the diagnosis of PE including patient characteristics, critical time intervals, diagnostic workup, treatment, and prognosis. PE patients were compared to the overall CPU patient cohort. Only patients with a complete 3-month follow-up were included. Results: Overall, 1.1% of all CPU patients were diagnosed with PE. Chest pain and dyspnea were the leading symptoms. Patients with PE were older, presented with higher heart rates, and more frequently exhibited signs of heart failure, despite a normal left ventricular function. PE patients showed significantly longer time delays between symptom onset and the first medical contact, while PE patients with chest pain presented earlier than PE patients with dyspnea only. Whereas more PE patients had to be transferred to the intensive care unit, in-CPU mortality and event rates over 3 months were low. Discussion/Conclusion: This study suggests a certain risk for underdiagnosis and consecutive potential undertreatment of PE patients in German Cardiac Society (GCS)-certified CPUs, which is thought to result from an anticipated focus on patients with acute coronary syndrome (ACS). Public awareness for PE beyond chest pain should be improved. Certified CPUs should be urged to implement strategic pathways for a better simultaneous diagnostic workup of differential diagnosis beyond ACS. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Allogeneic hand transplantation, a highly complex new surgical procedure, constitutes a major advancement in transplantation medicine. The preparation for the extraction of a donated hand is a critical indicator affecting patients' transplant surgery. This study revealed that the accuracy of surgical personnel's execution and their understanding of the extraction surgical procedure of the allogeneic hand was low. The causes included the following: 1) having limited knowledge of the storage method for a donated hand on ice, 2) lacking a container for storing and placing a donated hand, 3) and having limited knowledge of the repair surgery of a patient undergoing transplantation. The proposed improvement plan included conducting training and workshops on donated hand extraction, developing standard surgical procedures, purchasing containers for placing donated hands, and customizing prosthetic hands. After the improvement plan was implemented, the accuracy of the extraction procedure of surgical personnel increased from 50.3% to 99.6% and that of knowledge of extraction surgery increased to 99.1%. This indicates the value of this project in improving patient safety and medical quality associated with allogeneic donation extraction surgery. [ABSTRACT FROM AUTHOR]