Search

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.)

Introduction: The purpose of this study was to investigate the creation, implementation, and harmonisation of medical Standard Operating Procedures (SOP) in Finnish Helicopter Emergency Medical Services (HEMS). The research questions are: (1) What factors influence the creation and implementation of medical SOPs for Finnish HEMS units? and (2) What can be done to harmonise the medical SOPs of Finnish HEMS units? Methods: The research was conducted as a qualitative interview study with HEMS physicians who worked full-time in Finnish HEMS units or had worked in HEMS for more than five years. Three HEMS physicians from each of the six HEMS units in Finland participated in the study (n = 18). The thematic interviews (average duration 32 min) were transcribed (70,176 words in Finnish) and analysed using inductive content analysis. Results: The results of the first research question formed three main categories: (1) Background to developing medical SOPs and checklists (CLs), (2) Creation of medical SOPs in Finnish HEMS units, and (3) Implementation of medical SOPs and CLs. The main categories were divided into eight upper categories and twelve subcategories. The results of the second research question formed four main categories: (1) Prerequisites for harmonising procedures, (2) System-level changes needed, (3) Integrating common medical SOPs into HEMS, and (4) Cultural change. The main categories were divided into nine upper categories and nine subcategories. Conclusions: Medical SOPs and CLs are an integral part of Finnish HEMS. Each unit creates its own SOPs and CLs; their development, implementation, and follow-up are relatively unstructured. Harmonising existing SOPs would be possible, but developing common SOPs would require structural changes in HEMS and a stronger sense of community belonging among HEMS physicians. [ABSTRACT FROM AUTHOR]

Abstract Introduction The purpose of this study was to investigate the creation, implementation, and harmonisation of medical Standard Operating Procedures (SOP) in Finnish Helicopter Emergency Medical Services (HEMS). The research questions are: (1) What factors influence the creation and implementation of medical SOPs for Finnish HEMS units? and (2) What can be done to harmonise the medical SOPs of Finnish HEMS units? Methods The research was conducted as a qualitative interview study with HEMS physicians who worked full-time in Finnish HEMS units or had worked in HEMS for more than five years. Three HEMS physicians from each of the six HEMS units in Finland participated in the study (n = 18). The thematic interviews (average duration 32 min) were transcribed (70,176 words in Finnish) and analysed using inductive content analysis. Results The results of the first research question formed three main categories: (1) Background to developing medical SOPs and checklists (CLs), (2) Creation of medical SOPs in Finnish HEMS units, and (3) Implementation of medical SOPs and CLs. The main categories were divided into eight upper categories and twelve subcategories. The results of the second research question formed four main categories: (1) Prerequisites for harmonising procedures, (2) System-level changes needed, (3) Integrating common medical SOPs into HEMS, and (4) Cultural change. The main categories were divided into nine upper categories and nine subcategories. Conclusions Medical SOPs and CLs are an integral part of Finnish HEMS. Each unit creates its own SOPs and CLs; their development, implementation, and follow-up are relatively unstructured. Harmonising existing SOPs would be possible, but developing common SOPs would require structural changes in HEMS and a stronger sense of community belonging among HEMS physicians.

This article aims to help beginners in general practice and primary healthcare research clarify the standard operating procedures and understand that the "rigor" of case study is based on strict adherence to standard implementation procedures. The paper began with a literature review to sort out the development of case studies, overview the connotation, historical background, and applicable issues of case study. Then, the standard operational procedures of case study were introduced step by step, with specific examples to illustrate the application of case studies in general practice and primary healthcare. Step 1: plan initiation to determine whether to conduct a case study. Step 2: plan design to select appropriate cases and types of case study. Step 3: work preparation, researchers training and pilot study. Step 4: data collection to obtain data from multiple sources. Step 5: data analysis to obtain conclusions based on evidence. Step 6: report writing and communication with readers. Case study is suitable for addressing the "what" "how" and "why" questions in general practice and primary healthcare, with a broad application prospect.

Background: To support clinical decision-making at the point of care, the "best next step" based on Standard Operating Procedures (SOPs) and actual accurate patient data must be provided. To do this, textual SOPs have to be transformed into operable clinical algorithms and linked to the data of the patient being treated. For this linkage, we need to know exactly which data are needed by clinicians at a certain decision point and whether these data are available. These data might be identical to the data used within the SOP or might integrate a broader view. To address these concerns, we examined if the data used by the SOP is also complete from the point of view of physicians for contextual decision-making. Methods: We selected a cohort of 67 patients with stage III melanoma who had undergone adjuvant treatment and mainly had an indication for a sentinel biopsy. First, we performed a step-by-step simulation of the patient treatment along our clinical algorithm, which is based on a hospital-specific SOP, to validate the algorithm with the given Fast Healthcare Interoperability Resources (FHIR)-based data of our cohort. Second, we presented three different decision situations within our algorithm to 10 dermatooncologists, focusing on the concrete patient data used at this decision point. The results were conducted, analyzed, and compared with those of the pure algorithmic simulation. Results: The treatment paths of patients with melanoma could be retrospectively simulated along the clinical algorithm using data from the patients' electronic health records. The subsequent evaluation by dermatooncologists showed that the data used at the three decision points had a completeness between 84.6% and 100.0% compared with the data used by the SOP. At one decision point, data on "patient age (at primary diagnosis)" and "date of first diagnosis" were missing. Conclusions: The data needed for our decision points are available in the FHIR-based dataset. Furthermore, the data used at decision points by the SOP and hence the clinical algorithm are nearly complete compared with the data required by physicians in clinical practice. This is an important precondition for further research focusing on presenting decision points within a treatment process integrated with the patient data needed. [ABSTRACT FROM AUTHOR]

This study aimed to establish a precise preoperative high-risk factor scoring system and algorithm for antibiotic prophylaxis decision-making, provide guidance for the judicious use of AMP, refine interventions, and ensure the appropriate application of AMP for class I incisions in neurosurgery. According to PRISMA guidelines, literature searches, study selection, methodology development, and quality appraisal were performed. The quality of evidence across the study population was assessed using the Newcastle-Ottawa Scale. A two-round Delphi expert consultation method involved 15 experts from leading tertiary hospitals in China. Establishing an algorithm of SOPs for perioperative antimicrobial prophylaxis in Class I neurosurgical incisions. Thirteen studies, encompassing 11,936 patients undergoing clean neurosurgical procedures, were included. 791 patients experienced SSI, resulting in an average incidence of 6.62%. Identified risk factors significantly associated with an increased incidence of postoperative SSI (P < 0.05) included emergency surgery, preoperative hospitalization ≥7 days, intraoperative blood loss ≥300 mL, operation time ≥4 hours, diabetes mellitus, cerebrospinal fluid leakage, and repeat surgery. Sensitivity analysis demonstrated robust results for emergency surgery, intraoperative blood loss ≥300 mL, operation time ≥4 hours, cerebrospinal fluid leakage, and repeat surgery. Established a risk assessment system for Class I neurosurgical incisions by the Delphi method. Additionally, we have formulated an algorithm of SOPs for perioperative antimicrobial prophylaxis in Class I neurosurgical incisions. The established index for AMP utilization and SOPs in the preoperative period of class I neurosurgical incisions proves valuable, contributing to improved patient outcomes in neurosurgical procedures. [ABSTRACT FROM AUTHOR]

New onset refractory status epilepticus (NORSE), including its subtype with a preceding febrile illness known as febrile infection-related epilepsy syndrome (FIRES), is one of the most severe forms of status epilepticus. The exact causes of NORSE are currently unknown, and there is so far no disease-specific therapy. Identifying the underlying pathophysiology and discovering specific biomarkers, whether immunologic, infectious, genetic, or other, may help physicians in the management of patients with NORSE. A broad spectrum of biomarkers has been proposed for status epilepticus patients, some of which were evaluated for patients with NORSE. Nonetheless, none has been validated, due to significant variabilities in study cohorts, collected biospecimens, applied analytical methods, and defined outcome endpoints, and to small sample sizes. The NORSE Institute established an open NORSE/FIRES biorepository for health-related data and biological samples allowing the collection of biospecimens worldwide, promoting multicenter research and sharing of data and specimens. Here, we suggest standard operating procedures for biospecimen collection and biobanking in this rare condition. We also propose criteria for the appropriate use of previously collected biospecimens. We predict that the widespread use of standardized procedures will reduce heterogeneity, facilitate the future identification of validated biomarkers for NORSE, and provide a better understanding of the pathophysiology and best clinical management for these patients.

Strong reducing agents like lithium aluminum hydride (LiAlH4, LAH) are frequently employed by industry and academic laboratories in syntheses and other research applications. Due to LAH's reactivity, several laboratory explosions and fires have been documented in the literature and on various EH&S webpages at universities. Some of the accidents were caused by incorrect handling of LAH or by improper chemical processes, such as weighing on regular paper, grinding, and creating friction, using contaminated solvents and glassware, and physically scraping the material during transfers. In many of these cases, researchers did not have access to a guidance document or an SOP for many of these incidents, and no thorough risk assessment was carried out. Academic laboratories can avoid similar accidents and associated property damage by developing a safety guidance document that identifies every facet of LAH manipulation in the experiment, including reaction setup, procedures for weighing and transferring material to the reaction vessel, heating, and cooling during the reaction, quenching the reaction, and waste disposal. This LAH guidance document can be used to produce a manipulation-specific SOP that covers best practices and precautions for a variety of substrates and reaction scales. [ABSTRACT FROM AUTHOR]

Background: Managing nutrition in critically ill patients involves many medical fields. However, the nutrition management of critically ill patients has not been comprehensive enough to achieve multidisciplinary team cooperation in China and many other countries. Furthermore, there is no standardized management model or process. Aim: To explore the multidisciplinary cooperative nutrition management model for critically ill patients in the ICUs in China, verify its clinical effect and provide a clinical practice reference for the nutrition management of critically ill patients. Study Design: A multidisciplinary cooperative nutrition management team, including ICU doctors, ICU nurses, clinical nutritionists, clinical pharmacists and radiologists, was established for critically ill patients. According to a literature review and domestic guidelines, the standardized process of nutritional management for critically ill patients was constructed through the Delphi expert consultation method. One hundred thirty‐two patients in the ICU were randomly divided into an experimental group and a control group. A routine nutrition management mode, which was the nutrition management plan mainly formulated by the ICU doctor in charge only and the ICU nurses responsible for the implementation and monitoring of nutrition support, was implemented in the control group. And a multidisciplinary nutrition management mode, which was the nutrition management implemented by the multidisciplinary teams with the standardized nutrition management process for critically ill patients, was adopted in the experimental group. The early nutritional support rate, nutritional indexes (serum albumin, preprotein, haemoglobin and hs‐CPR), mechanical ventilation time, ICU hospitalization days and hospitalization expenses of the two groups were compared. Results: The early nutritional support rates of the experimental group and the control group were 89.39% and 69.7%, respectively (χ2 =.002, p =.031). Serum albumin (35.4 vs. 33.1 g/L), preprotein (153.2 vs. 125.9 mg/L) and haemoglobin (97.5 vs. 90.6 g/L) in the experimental group were significantly higher than in the control group (p =.000,.016,.033). The days of hospitalization in the ICU of the experimental group were shorter than in the control group (5.1 vs. 7.1, p =.039). High‐sensitivity C‐reactive protein, the days of mechanical ventilation and ICU hospitalization expenses of the experimental group were lower than in the control group; however, the difference was not statistically significant (p =.713,.068,.489). Conclusions: Because of the severity and complexity of patients' diseases, it is necessary to implement multidisciplinary nutrition management for critically ill patients. Research shows that the multidisciplinary nutrition management standardized process for critically ill patients that was constructed in this study can effectively improve nutritional indexes such as serum albumin, preprotein and haemoglobin, shorten the length of stay in the ICU and promote the rehabilitation of patients, and this process be widely used in the clinic. Relevance to Clinical Practice: Structured multidisciplinary nutrition management operational processes can guide clinical practice. They could be widely used in the clinical nutrition management of critically ill patients in critical care units or other departments. [ABSTRACT FROM AUTHOR]

Africanized bees have spread across the Americas since 1956 and consequently resulted in human and animal deaths attributed to massive attacks related to exposure from Argentina to the USA. In Brazil, more than 100,000 accidents were registered in the last 5 years with a total of 303 deaths. To treat such massive attacks, Brazilian researchers developed the first specific antivenom against Africanized honey bee sting exposure. This unique product, the first of its kind in the world, has been safely tested in 20 patients during a Phase 2 clinical trial. To develop the antivenom, a standardized process was undertaken to extract primary venom antigens from the Africanized bees for immunization of serum-producing horses. This process involved extracting, purifying, fractionating, characterizing, and identifying the venom (apitoxin) employing mass spectrometry to generate standardized antigen for hyperimmunization of horses using the major toxins (melittin and its isoforms and phospholipase A2). The current guide describes standardization of the entire production chain of venom antigens in compliance with good manufacturing practices (GMP) required by regulatory agencies. Emphasis is placed upon the welfare of bees and horses during this process, as well as the development of a new biopharmaceutical to ultimately save lives. [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.)

With digital patient data increasing due to new diagnostic methods and technology, showing the right data in the context of decision support at the point of care becomes an even greater challenge. Standard operating procedures (SOPs) modeled in BPMN (Business Process Model and Notation) contain evidence-based treatment guidance for all phases of a certain diagnosis, while physicians need the parts relevant to a specific patient at a specific point in the clinical process. Therefore, integration of patient data from electronic health records (EHRs) providing context to clinicians is needed, which is stored and communicated in HL7 (Health Level Seven) FHIR (Fast Healthcare Interoperability Resources). To address this issue, we propose a method combining an integration of stored data into BPMN and a loss-free transformation from BPMN into FHIR, and vice versa. Based on that method, an identification of the next necessary decision point in a specific patient context is possible. We verified the method for treatment of malignant melanoma by using an extract of a formalized SOP document with predefined decision points and validated FHIR references with real EHR data. The patient data could be stored and integrated into the BPMN element 'DataStoreReference'. Our loss-free transformation process therefore is the foundation for combining evidence-based knowledge from formalized clinical guidelines or SOPs and patient data from EHRs stored in FHIR. Processing the SOP with the available patient data can then lead to the next upcoming decision point, which will be displayed to the physician integrated with the corresponding data. [ABSTRACT FROM AUTHOR]

The belief that a good law demands preemptive obedience to maintain its stability and reliability seems to run counter to scientific critical thinking, which is to think independently and question assumptions. This study discusses possible decisions by different laboratories with different research purposes in disposing of an alkali metal. Through the analysis, we consider why scientists follow or violate relevant safety rules. Using Joseph Raz's service conception of authority and legal philosophers' observations, we have found that to reduce the risk of accidents caused by professional autonomy and rational noncompliance, the academic community should focus on improving and deferring to the preemptive qualified legislative authority, which should exercise its power cautiously to avoid marginalizing public interests. [ABSTRACT FROM AUTHOR]

Background: Peripartum haemorrhage (PPH) is a potentially life-threatening complication. Although still rare, the incidence of peripartal haemorrhage is rising in industrialised countries and refractory bleeding remains among the leading causes of death in the peripartal period. Summary: The interdisciplinary German, Austrian, and Swiss guideline on "Peripartum Haemorrhage: Diagnostics and Therapies" has reviewed the evidence for the diagnostics and medical, angiographic, haemostatic, and surgical treatment and published an update in September 2022. This article reviews the updated recommendations regarding the early diagnosis and haemostatic treatment of PPH. Keystones of the guideline recommendations are the early diagnosis of the bleeding by measuring blood loss using calibrated collector bags, the development of a multidisciplinary treatment algorithm adapted to the severity of bleeding, and the given infrastructural conditions of each obstetric unit, the early and escalating use of uterotonics, the therapeutic, instead of preventative, use of tranexamic acid, the early diagnostics of progressive deficiencies of coagulation factors or platelets to facilitate a tailored and guided haemostatic treatment with coagulation factors, platelets as well as packed red blood cells and fresh frozen plasma when a massive transfusion is required. Key Messages: Essential for the effective and safe treatment of PPH is the timely diagnosis. The diagnosis of PPH requires the measurement rather than estimation of blood loss. Successful treatment of PPH consists of a multidisciplinary approach involving surgical and haemostatic treatments to stop the bleeding. Haemostatic treatment of PPH starts early after diagnosis and combines tranexamic acid, an initially ratio-driven transfusion with RBC:plasma:PC = 4:4:1 (when using pooled or apheresis PC) and finally a goal-directed substitution with coagulation factor concentrates for proven deficiencies. Early monitoring of coagulation either by standard parameters or viscoelastic methods facilitates goal-directed haemostatic treatment. [ABSTRACT FROM AUTHOR]

Purpose - This research aims to analyze the application of cleanliness, health, safety, and environmental sustainability (CHSE) certification in the hotel business sector during the COVID-19 pandemic from the managers' perspective. Methodology/Design/Approach - A qualitative research method was adopted and data were collected through in-depth interviews with 35 hotel managers. Six main themes were identified in the thematic analysis, including hotel business conditions during the COVID-19 pandemic, health conditions, cleanliness, safety measures and procedures, environmental sustainability practices, and perceptions of managers about CHSE certification. Findings - Results indicated that health protocol standards were the top priority of current management, followed by cleanliness and procedures to maintain guest and hotel employee safety. Originality of the research - This research provided theoretical implications regarding hotel business certification and standards during a pandemic, with cleanliness, health, safety, and environment being the top priorities. Operational implications showed that CHSE certification provided operational standards for the hotel industry during the pandemic and ensured guest safety and comfort. Based on these results, further research is recommended to obtain data from regulatory agencies that set certification policies, including the government, hotel guests, and hotel staff. [ABSTRACT FROM AUTHOR]

Infusion therapy involves the intravenous administration of drugs, fluids, and blood products to hospitalized clients. This study aimed to identify factors influencing nurse compliance in monitoring infusion fluids according to Standard Operating Procedures (SOPs). The research adopted a quantitative approach with a descriptive correlational design and a cross-sectional approach, focusing on a study population of 50 nurses. Data collection utilized observation techniques and questionnaires as research instruments, with the analysis employing Kendall's Tau B and Kendall's Tau C methods. The findings revealed significant correlations between age (p-value=0.000), education (p-value=0.006), career path level (p-value=0.013), and knowledge (p-value=0.011). However, there was no significant relationship between the length of work experience and nurse compliance in monitoring infusion fluids (p-value=0.257) according to SOPs in this private hospital. To enhance the quality of care, it is recommended that nurses receive additional training provided by the nursing education team at the hospital, focusing specifically on the monitoring of infusion fluids. This targeted training could contribute to reducing instances of complaints related to mismatched patient needs and ultimately improve compliance with established SOPs in infusion therapy.

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 to have standard operating procedures and include education and training staff.

Introduction: Good Clinical Laboratory Practices (GCLP) play a vital role in early and accurate diagnosis, providing highquality data, and timely sample processing. Adhering to a robust Quality Management System (QMS) that complies with GCLP standards is crucial for laboratory personnel in a clinical laboratory to deliver outstanding healthcare services and reliable, reproducible reports. Aim: To assess the Knowledge, Attitude, and Practice (KAP) of laboratory professionals towards quality in the laboratory through GCLP training. Materials and Methods: This pre-test, post-test quasiexperimental study was conducted in the Department of Biochemistry at ESIC Medical College and Hospital, Faridabad, Haryana, India, from February 2022 to June 2022. The study included 58 participants, consisting of 22 doctors and the remaining laboratory assistants. GCLP online training program was conducted every Friday in March 2022 for four weeks. An online questionnaire containing 34 questions was administered to all the participants before and after the training. Data were collected and analysed using a paired t-test. Results: A total of 58 responses were received from the participants via Google form before and after the training. The results indicate no significant difference in participants’ responses to 12 closed-ended questions regarding QMS before and after training. A similar trend was observed for 22 questions on a Likert scale, where participants rated their agreement, neutrality, or disagreement. Conclusion: The study demonstrates that all technical staff fully complied with GCLP guidelines and accreditation requirements. Furthermore, the laboratory staff acknowledges the importance of Standard Operating Procedures (SOPs), document maintenance, record-keeping, and identifying nonconformities, all of which contribute to effective traceability of the testing process in the clinical laboratory.

Purpose – This research aims to analyze the application of cleanliness, health, safety, and environmental sustainability (CHSE) certification in the hotel business sector during the COVID-19 pandemic from the managers’ perspective. Methodology/Design/Approach – A qualitative research method was adopted and data were collected through in-depth interviews with 35 hotel managers. Six main themes were identified in the thematic analysis, including hotel business conditions during the COVID-19 pandemic, health conditions, cleanliness, safety measures and procedures, environmental sustainability practices, and perceptions of managers about CHSE certification. Findings – Results indicated that health protocol standards were the top priority of current management, followed by cleanliness and procedures to maintain guest and hotel employee safety. Originality of the research – This research provided theoretical implications regarding hotel business certification and standards during a pandemic, with cleanliness, health, safety, and environment being the top priorities. Operational implications showed that CHSE certification provided operational standards for the hotel industry during the pandemic and ensured guest safety and comfort. Based on these results, further research is recommended to obtain data from regulatory agencies that set certification policies, including the government, hotel guests, and hotel staff.

Background: To support clinical decision-making at the point of care, the “best next step” based on Standard Operating Procedures (SOPs) and actual accurate patient data must be provided. To do this, textual SOPs have to be transformed into operable clinical algorithms and linked to the data of the patient being treated. For this linkage, we need to know exactly which data are needed by clinicians at a certain decision point and whether these data are available. These data might be identical to the data used within the SOP or might integrate a broader view. To address these concerns, we examined if the data used by the SOP is also complete from the point of view of physicians for contextual decision-making. Methods: We selected a cohort of 67 patients with stage III melanoma who had undergone adjuvant treatment and mainly had an indication for a sentinel biopsy. First, we performed a step-by-step simulation of the patient treatment along our clinical algorithm, which is based on a hospital-specific SOP, to validate the algorithm with the given Fast Healthcare Interoperability Resources (FHIR)-based data of our cohort. Second, we presented three different decision situations within our algorithm to 10 dermatooncologists, focusing on the concrete patient data used at this decision point. The results were conducted, analyzed, and compared with those of the pure algorithmic simulation. Results: The treatment paths of patients with melanoma could be retrospectively simulated along the clinical algorithm using data from the patients’ electronic health records. The subsequent evaluation by dermatooncologists showed that the data used at the three decision points had a completeness between 84.6% and 100.0% compared with the data used by the SOP. At one decision point, data on “patient age (at primary diagnosis)” and “date of first diagnosis” were missing. Conclusions: The data needed for our decision points are available in the FHIR-based dataset. Furthermore, the data used at decision points by the SOP and hence the clinical algorithm are nearly complete compared with the data required by physicians in clinical practice. This is an important precondition for further research focusing on presenting decision points within a treatment process integrated with the patient data needed.

The aim of this research is to 1) determine the application of standard operational procedures for ambulance referral services at the Andong Community Health Center based on PERMENKES Number 71 of 2013, 2) determine the obstacles to the Community Health Center in providing referral services. Sociological juridical research method with a qualitative approach. The primary data source is text from interviews and was obtained through interviews with informants in the research. Secondary data is data obtained by researchers by studying literature such as journals, articles, books, documents and others. Data collection techniques were carried out by means of interviews, observations and documents. There are several stages in the qualitative descriptive analysis technique, namely data reduction, data presentation, and verification. The results of the research show that the SOP for the use of ambulances in referral services at the Andong Health Center is in accordance with the existing SOP, however the SOP for the use of ambulances in referral services must be further improved so that it is optimally in accordance with PERMENKES Number 17 of 2013. The main objective of the SOP is to provide guidance or guidance on using an ambulance. The obstacle to the Puskesmas in providing referral services is the lack of human resources (drivers) consisting of 1 person with 2 ambulances. Meanwhile, the infrastructure is in accordance with basic ambulance service standards. The conclusion of this research is that the application of standard operational procedures is very effective and efficient in improving ambulance referral services at the Andong Community Health Center and resolving barriers to referral services.

Introduction: Good Clinical Laboratory Practices (GCLP) play a vital role in early and accurate diagnosis, providing high-quality data, and timely sample processing. Adhering to a robust Quality Management System (QMS) that complies with GCLP standards is crucial for laboratory personnel in a clinical laboratory to deliver outstanding healthcare services and reliable, reproducible reports. Aim: To assess the Knowledge, Attitude, and Practice (KAP) of laboratory professionals towards quality in the laboratory through GCLP training. Materials and Methods: This pre-test, post-test quasi-experimental study was conducted in the Department of Biochemistry at ESIC Medical College and Hospital, Faridabad, Haryana, India, from February 2022 to June 2022. The study included 58 participants, consisting of 22 doctors and the remaining laboratory assistants. GCLP online training program was conducted every Friday in March 2022 for four weeks. An online questionnaire containing 34 questions was administered to all the participants before and after the training. Data were collected and analysed using a paired t-test. Results: A total of 58 responses were received from the participants via Google form before and after the training. The results indicate no significant difference in participants' responses to 12 closed-ended questions regarding QMS before and after training. A similar trend was observed for 22 questions on a Likert scale, where participants rated their agreement, neutrality, or disagreement. Conclusion: The study demonstrates that all technical staff fully complied with GCLP guidelines and accreditation requirements. Furthermore, the laboratory staff acknowledges the importance of Standard Operating Procedures (SOPs), document maintenance, record-keeping, and identifying nonconformities, all of which contribute to effective traceability of the testing process in the clinical laboratory. [ABSTRACT FROM AUTHOR]

Research integrity (RI) guidance documents often lack sufficient details on handling specific RI issues causing the lack of harmonized approaches to RI and opening the way to research misconduct and other detrimental research practices. Standard operating procedures (SOPs) are developed and implemented by organizations for ensuring the uniformity and quality of performed actions. This study aimed to explore stakeholders' opinions on SOPs for RI, factors influencing the implementation of RI guidance documents and practices, and ideas for improvements in the RI field. We conducted semi-structured interviews with stakeholders from different groups. Data were analyzed using the reflexive thematic analysis approach, and three themes were developed. The first theme addressed participants' knowledge and perceptions on SOPs for RI and their impact on RI promotion and implementation. The second theme described different factors that have a positive or negative impact on the implementation of RI and RI guidance documents and practices, while the third theme addressed needed changes and ideas for improvements in the RI field. Participants considered SOPs valuable for RI promotion. SOPs should be developed based on and consistent with more general and aspirational guidance and through the dialogue with researchers and other stakeholders, to ensure their relevancy. [ABSTRACT FROM AUTHOR]

Initiated through Presidential direction and now codified, the National Ocean Mapping, Exploration, and Characterization (NOMEC) Council comprises leaders from U.S. federal agencies with a shared goal of mapping all waters of the United States and exploring and characterizing priority areas. The NOMEC Council’s two Interagency Working Groups, Ocean and Coastal Mapping (IWG-OCM) and Ocean Exploration and Characterization (IWG-OEC), both achieved major milestones recently with the 2023 release of the Draft Standard Ocean Mapping Protocols (SOMP) and the 2022 publication of the National Priorities for Ocean Exploration and Characterization. Building on this groundwork, the IWG-OEC is now looking to define and share best practices, guidelines, and resources for ocean exploration and characterization with the long-term goal of increasing community wide standardization to help achieve consistent common practices. First, the IWG-OEC plans to compile federal agency resources and share them in a newly developed online resource repository. The next phase is for the IWG-OEC to create opportunities for non-federal sectors to provide input on developing and populating this repository with additional content (existing standards and protocols, best practice and guidelines documents, etc.). After experts representing multiple sectors are identified, a series of results-oriented workshops are planned to provide input on all aspects of the data, products, and services from exploration and characterization. Finally, the IWG-OEC plans to widely share the online repository of best practices and standard operating procedures. A systematic, transparent, and collaborative process to share standards and protocols can help to enhance the interoperability of data and inform new lines of inquiry, discovery, research, and innovation.

As notified in the New Drugs and Clinical Trials Rules 2019, ethics committees (ECs), intending to review and oversee the conduct of Biomedical and Health Research (BHR) shall be required to register with the authority designated by the Central Government in the Ministry of Health and Family Welfare, Department of Health Research (DHR). The entire process of receiving and processing such applications is done online through the Naitik portal. Vide these rules, it has become mandatory for all institutions/entities whether publicly or privately conducting or intending to conduct BHR involving the human participants, to get their EC, registered with the DHR. A status report of the functioning of the National Ethics Registry and an analysis of ECs registered with the DHR are presented in this manuscript. A workflow of the processing involved in EC registration is given with sectorial segregation, and analysis of data on ECs across the country is made for the dissemination and information. This article elaborates on the registration requirements and process of the EC registry with the necessity of being registered with the DHR. 2100 login requests and more than 1560 applications for registration have been received; private hospitals and medical colleges have been the front-runner in getting their organization registered, and organizations in the commercial sector are faring better in terms of EC registration. Further dissemination and outreach efforts have to be made to draw the attention of various stakeholders regarding this requirement and thereby ensuring that all ECs in the country are registered with the DHR. [ABSTRACT FROM AUTHOR]

Introduction: Ayurvedic formulations have a long history of use and have increased amazingly to follow the global interest in natural products. However, for many classical ayurvedic formulations, no quality parameters of standardization are available. Vyoshadi Churna, a classical Ayurvedic polyherbal formulation that cures indigestion and diarrhea, is being used since ancient times. However, there is no standard method available for its formulation and evaluation. Hence, the current study aims to develop the quality standards for Vyoshadi churna. Methods: The standard procedures for preparation and standardization of Churna described in Ayurvedic Pharmacopoeia of India (API) were used in the present study. Standardization includes pharmacognostical, chromatographic, and physico-chemical studies. The other essential studies were also done in accordance to API and World Health Organization guidelines to find the limits of microbial load, aflatoxin, heavy metals, and pesticide residue using modern analytical techniques such as gas chromatography-mass spectroscopy (MS) and inductively coupled plasma-MS/MS. Results: Vyoshadi Churna is of brown color and bitter in taste. Pharmacognostical studies have shown the characteristic features of almost each contributory crude drug. A unique chemical profile was also developed using toluene: ethyl acetate: methanol: formic acid (4:4:1:0.5) as the mobile phase to resolve maximum components. Furthermore, the standardized limits for the physicochemical studies, microbial load, heavy metals, aflatoxins, and pesticide residues were established and found in limits. Conclusion: This is for the first time when the standard operating procedure of Vyoshadi Churna was developed. Hence, the current technical work would be practically helpful for the future preparation and standardization study of Vyoshadi Churna.

Research biobanks are non-profit structures that collect, manipulate, store, analyze and distribute systematically organized biological samples and data for research and development purposes. Over the recent years, we have established a biobank, the Rheumatology BioBank (RheumaBank) headed by the Medicine and Rheumatology unit of the IRCCS Istituto Ortopedico Rizzoli (IOR) in Bologna, Italy for the purpose of collecting, processing, storing, and distributing biological samples and associated data obtained from patients suffering from inflammatory joint diseases. RheumaBank is a research biobank, and its main objective is to promote large-scale, high-quality basic, translational, and clinical research studies that can help elucidate pathogenetic mechanisms and improve personalization of treatment choice in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other spondyloarthritides (SpA).

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 FROM AUTHOR]

Abstract 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.

This article aims to reduce harm and improve patient safety in dentistry by providing evidence-based guidance on the prevention, recognition, management, and reporting of sodium hypochlorite injuries occurring in the course of endodontic dental treatment. In contrast to previous publications all types of sodium hypochlorite harm and near-harm events in the dental setting are considered, to offer the reader an all-encompassing clinical guide for reference. [ABSTRACT FROM AUTHOR]

This study critically examines the role of legal safeguards in enhancing healthcare service quality. Utilizing normative legal research methods, the study employs legislative and conceptual approaches to explore the dual nature of legal protection: preventive and repressive, in the context of healthcare professionals adhering to established Standard Operating Procedures (SOPs). The findings suggest that healthcare practitioners' negligence level and the resultant harm to patients or the public determines the legal implications. Such implications range from allegations of SOP and ethical code violations, to civil litigation for damages, and even criminal charges if medical actions endanger lives, potentially causing patient mortality. Therefore, the study highlights the necessity for legal accountability for healthcare practitioners, emphasizing that their service delivery must align with the set SOPs. These findings have profound implications for policy-making, emphasizing the need for robust legal protection for both healthcare practitioners and service recipients, thereby ensuring improved healthcare service quality. Highlights: • Dual nature of legal protection in healthcare. • Negligence level dictates legal consequences. • Emphasis on healthcare practitioners' legal accountability. Keywords: Legal Protection, Healthcare Services, Medical Negligence, Standard Operating Procedures, Legal Consequences

With digital patient data increasing due to new diagnostic methods and technology, showing the right data in the context of decision support at the point of care becomes an even greater challenge. Standard operating procedures (SOPs) modeled in BPMN (Business Process Model and Notation) contain evidence-based treatment guidance for all phases of a certain diagnosis, while physicians need the parts relevant to a specific patient at a specific point in the clinical process. Therefore, integration of patient data from electronic health records (EHRs) providing context to clinicians is needed, which is stored and communicated in HL7 (Health Level Seven) FHIR (Fast Healthcare Interoperability Resources). To address this issue, we propose a method combining an integration of stored data into BPMN and a loss-free transformation from BPMN into FHIR, and vice versa. Based on that method, an identification of the next necessary decision point in a specific patient context is possible. We verified the method for treatment of malignant melanoma by using an extract of a formalized SOP document with predefined decision points and validated FHIR references with real EHR data. The patient data could be stored and integrated into the BPMN element ‘DataStoreReference’. Our loss-free transformation process therefore is the foundation for combining evidence-based knowledge from formalized clinical guidelines or SOPs and patient data from EHRs stored in FHIR. Processing the SOP with the available patient data can then lead to the next upcoming decision point, which will be displayed to the physician integrated with the corresponding data.

High-quality and well-annotated biorepositories are needed to better understand the pathophysiology and biologic mechanisms of chronic pancreatitis (CP) and its consequences. We report a methodology for the development of a robust standard operating procedure (SOP) for a biorepository based on the experience of the clinical centers within the consortium to study Chronic Pancreatitis, Diabetes and Pancreas Cancer Clinical Centers (CPDPC), supported by the National Cancer Institute and the National Institute for Diabetes and Digestive and Kidney Diseases as a unique multidisciplinary model to study CP, diabetes, and pancreatic cancer in both children and adults. Standard operating procedures from the CPDPC centers were evaluated and consolidated. The literature was reviewed for standard biorepository operating procedures that facilitated downstream molecular analysis. The existing literature on biobanking practices was harmonized with the SOPs from the clinical centers to produce a biorepository for pancreatic research. This article reports the methods and basic principles behind the creation of SOPs to develop a biorepository for the CPDPC. These will serve as a guide for investigators developing biorepositories in pancreas research. Rigorous and meticulous adherence to standardized biospecimen collection will facilitate investigations to better understand the pathophysiology and biologic mechanisms of CP, diabetes, and pancreatic cancer.

Background: The achievement parameter for maternal health services program is the access of pregnant health services, as indicated by measuring the coverage of antenatal care services. In Indonesia, examination of pregnant women according to antenatal standards is regulated by Ministry of Health Indonesia Number 21 of 2021, where pregnancy checks must fulfill the standard 10 T criteria. Aims: This study aimed to identify the Standard Operating Procedures of antenatal care in Gamping I Public Health Center, Yogyakarta, Indonesia, and determine its relation with pregnant women’s satisfaction during pregnancy examination. Methods: Of 70 TM III pregnant women, who routinely visit for antenatal care service at the Public Health Center Gamping I, a total of 40 pregnant women were selected using consecutive sampling with 10% margin of error. A set of questionnaires was distributed to the respondents to asses: (1) The implementation of the antenatal care service standard (20 questions, and weighted using a dichotomy scale) and (2) The pregnant women satisfaction (22 questions, and weighted using the Likert scale. The data obtained from respondents were then tabulated and processed using Microsoft Office Excel 2010 and then analyzed using the SPSS Statistics 16.0 program (Pearson Product Moment formula with an error rate of 5%). Results: There are 10 pregnancy tests (10T) received by the pregnant women at the health center including the measurement of Height, Weight, Blood pressure, upper arm circumference, Uterine fundus height, Presentation & Fetal heart rate, Provision of 90 Fe Tablets, Laboratory examinations, Case handling, TT Immunization Screening, and Counseling & mental health assessment. According to the findings of the research conducted by the researchers, antenatal examinations were not carried out in a comprehensive and thorough manner in instances. This article provides the women satisfaction to the antennal care on different dimensions of satisfaction including Physical Proof, Reliability, Responsiveness, Guarantee, and Empathy. Even though the analysis shows that the respondents was satisfied with the antennal care services; however, the relation is not statistically significant (p-value of 0.652). Conclusion : One's satisfaction is very difficult to measure and someone's satisfaction is different from the satisfaction of someone else. According to the findings of the study, every time a midwife performed an antenatal checkup, she had never provided complete 10T-based antenatal care. In addition, this research has been carried out through direct observation of prenatal care, where pregnant women and midwives' perceptions of antenatal care examinations do not differ.

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. [ABSTRACT FROM AUTHOR]

Background: Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP.Methodology: A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE - this date is used to separate the cohort groups.Results: Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251.Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001).Conclusion: This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation. [ABSTRACT FROM AUTHOR]