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Publisher Copyright: © 2021 The Authors Objective: Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. The use of medications increases the rate of successful airway management compared with nonmedication ETI and may also improve outcomes in patients with traumatic brain injury. In the absence of an operative emergency physician and with long distances, paramedic-induced airway management may increase the survival of patients in selected scenarios. A paramedic-staffed helicopter emergency medical system in Northern Finland operates in a rural area without an emergency physician and paralytic medications and treats critically ill patients using basic or advanced life support ground units. The aim of this study was to evaluate the success rates of ETI performed by a small, appropriately trained, and experienced group of 8 nurse paramedics in an out-of-hospital setting. Methods: The inclusion criterion for the study was an attempted intubation in patients with medical or traumatic indication for airway management by nurse paramedic. Results: Fifty-one patients were treated with ETI. The first-pass success rate was 72.5%, the second-pass success rate was 94.1%, and the overall success rate was 100% within 4 attempts. The median on-scene time was 54 minutes, and there were no signs of aspiration during laryngoscopy or after successful ETI. The primary mortality rate was 11.7%. Conclusion: The use of a rigid standard operating procedure for paramedic rapid sequence induction, paralytics, a video laryngoscope, and a gum elastic bougie might positively affect the ETI first-pass success rate. A follow-up study after these future modifications is needed. This small study suggests that intubation might be 1 option for airway management by an experienced nonanesthesiologist in Lapland.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has severely affected the provision of health-care services in hospitals around the world, including bringing challenges to those who perform surgical procedures. Multidepartment data analysis will reflect the pandemic’s impact and challenges in managing surgical cases in various surgery departments. AIM: This study aims to assess the impact of COVID-19 lockdowns on surgical cases carried out in eight tertiary care center surgery departments. METHODS: Retrospective data from all patients in the eight surgery departments of Dr. Moewardi General Hospital, Surakarta, during the lockdown period due to COVID-19 were collected and compared to the period before the lockdown. Then, the data were analyzed regarding the effects of following the standard operating procedure for surgical services in the hospital during the lockdown period. RESULTS: All the surgery departments involved in the study showed a significant reduction in the number of patients treated during the lockdown period than before the lockdown, with a total number of cases across all departments of 2432, a decrease from 4503 before the lockdown. In surgical patient care, several special measures during the COVID-19 pandemic were carried out in outpatient, intraoperative, and inpatient services to reduce the virus spread to patients and health workers. CONCLUSION: The COVID-19 pandemic has severely affected the provision of health services in hospitals with a reduction in the number and types of patients in each surgery department, and the obligation to follow hospital protocols against COVID-19 has resulted in various treatments and services being delayed in all surgery departments.

The mission of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is to innovate, educate, and collaborate to improve patient care. A critical element in meeting this mission is the publishing of trustworthy and current guidelines for the practicing surgeon. In this manuscript, we outline the steps of developing high quality practice guidelines using a completely volunteer-based professional organization. SAGES has developed a standardized approach to train volunteer surgeons and trainees alike to develop clinically pertinent guidelines in a timely manner, without sacrificing quality. This methodology can be used more widely by volunteer organizations to efficiently develop effective tools for practicing physicians.

Treatment of pemphigus poses a significant challenge in dermatology practice. Rituximab has recently been accepted as a first-line drug for pemphigus. This article tries to propose a standard operating procedure for the administration of rituximab.

This Standard Operating Protocol (SOP) describes the key steps of experimental setup for an inhibition assay of enzymatic activity. The protocol begins with the design of an experiment, including the choice of a catalytic reaction, optimal conditions, fraction and concentration of the active enzyme, substrate and inhibitor concentrations and the positive and negative controls. The protocol ends with the data analysis followed by a typical example of an experiment. Despite an apparently standard procedure, the assay has a number of possible pitfalls such as low fraction of the active enzyme or errors in the analysis such as application of an improper model or incorrect determination of the inhibition constant while not recognizing the dependence on enzyme concentration. The protocol provides examples of necessary steps and controls to avoid these problems and obtain highly reliable results.

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (

In the previous decades, distance learning in (medical) education, has taken flight worldwide. Many medical educational institutions have successfully embraced online distance learning (ODL), with online courses now being delivered by a great number of organisations, ranging from community colleges to renowned universities all around the globe.1–4 The current era of physical distancing in light of the COVID-19 pandemic has further underscored the need for online learning programmes for healthcare professionals. Although some medical educators with a degree in teaching may have abundant experience in developing and hosting online training programmes (eg, ODL postgraduate programmes), many clinical teachers, for example, physicians, nurses and other allied healthcare professionals, may feel quite hesitant and out of their depth when faced with the request to provide their lectures or trainings online instead of face to face. Without previous training and/or specific expertise, developing and presenting an engaging e-learning can be quite a challenge. To help overcome this practical dilemma, we have developed a robust standard operating procedure (SOP) for clinical teachers with limited experience in online teaching on how to develop and host an engaging webinar. A webinar, an aggregation of the words ‘web-based’ and ‘seminar’ can be defined as a presentation, lecture or workshop which is transmitted real time through the internet with the option to interact with the presenter and/or other participants.5 Alternatively, a recording of the webinar can often be viewed at a later moment but does not offer the option of live interaction. Webinar history parallels that of the internet with the appearance of predecessors like real-time text messaging apps emerging at the end of 1980s, followed by web chats and instant messaging apps in the mid 1990s, to the registration of the trademark ‘webinar’ in 1998.6 With today’s available software, it is no longer deemed …

The clinical research we do to improve our understanding of disease and to develop new therapies has temporarily been delayed as the global health-care enterprise has focused its attention on those impacted by coronavirus disease 2019 (COVID-19). Although rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are decreasing in many areas, many locations continue to have a high prevalence of infection. Nonetheless, research must continue and institutions are considering approaches to restarting non-COVID-related clinical investigation. Those restarting respiratory research must navigate the added planning challenges that take into account outcome measures that require aerosol-generating procedures. Such procedures potentially increase risk of transmission of SARS-CoV-2 to research staff, use limited personal protective equipment, and require conduct in negative-pressure rooms. One must also be prepared to address the potential for COVID-19 resurgence. With research subject and staff safety and maintenance of clinical trial data integrity as the guiding principles, here we review key considerations and suggest a step-wise approach for resuming respiratory clinical research.

The Coronavirus (COVID-19) pandemic and institution of the Movement Control Order (MCO) had resulted in the cancellation of a major orthopaedic exam in April 2020. The exam is known as the Malaysian Orthopaedic Specialist Committee (OSC) Part I Examinations. It is similar to the British Royal Colleges of Surgeons Membership (MRCS) exams and held twice annually in April and October. There are up to 200 candidates involved. With implementation of new guidelines and standard operating procedures (SOP), the OSC Part I exam was successfully held by Universiti Kebangsaan Malaysia (UKM) from 5th-9th October 2020. Here we highlight the challenges we faced whilst coordinating a major exam at a national level during the COVID-19 pandemic with recommendations for future exams.

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

Aim: In this study, we aim to evaluate the perception and practice of IPC measures by Radiologists during pre-COVID and present COVID times, while conducting a thorough review of current concepts and literature, to provide a standard operating procedure (SOP) for radiology operations. Methods: This study was conducted by Department of Radiodiagnosis and Imaging, Kasturba Medical College, MAHE, Mangalore. After obtaining approval from the institutional ethics committee, and other required permissions, the Google form questionnaire was sent to 350 Radiologists via email and text during the period of May 2020. Data was collected by time-based sampling in the period of fifteen days during the end of the total lockdown time. Results: 54% (n = 152) reported never attending a training session on (Infection Prevention & Control) IPC prior to the COVID-19 outbreak. The perception regarding IPC were found to be good among radiologists as majority of the respondents were correctly able to answer questions regarding IPC. 86% (n = 152) of the respondents believed that their knowledge on IPC has improved during the COVID-19 pandemic. However, it was revealed that majority of the respondents only started to practice appropriate contact and droplet / procedural precautions only after the COVID-19 outbreak. Conclusion: The present COVID-19 scenario coupled with the lack of knowledge and training regarding IPC amongst radiologists evident from the results of our survey, highlights the need for proper training and establishing standard operating procedures and best practices in IPC pertinent to modern radiology practice

Toddlers are the age group that most often suffer from malnutrition and lack of nutrition. Based on data from the Batam City Health Office in 2017 regarding the scope of monitoring the growth and development of infants at 49.6% of the target set by the Ministry of Health of the Republic of Indonesia which is 80%. Baloi Permai Public Health Center is the lowest public health center with 35.8% achievement coverage. This study aims to analyze of monitoring growth and development of toodlers in the working area of Baloi Permai Public Health Center. The study design used qualitative methods. The number of informants in this study were 8 people. Data analysis using content analysis methods. The results of this study indicate that coordination of growth and development monitoring for toddlers is pooled interdependence, lack of standard operating procedure and standardization of skills. Indirect supervision in the form of recording and reporting has not been implemented. Coordination in monitoring the growth and development of toddlers in the working area of Baloi Permai Public Health Center is not optimal so it needs cooperation with related parties and the active role of all parties to reach the scope of growth and development of toddlers.

Microbial contamination in chicken meat is caused by unsanitary practices during slaughtering in poultry slaughtering house. Poultry slaughtering house need to apply Good Manufacturing Practice (GMP) and Sanitation Standard Operating Procedure (SSOP) system to produce the standard microbial requirements of meat. This study was aimed to evaluate the implementation of GMP and SSOP and categorize 30 slaughtering houses located in Bogor. Observation was carried out in 4 modern slaughtering houses (RPH-U) and 26 traditional slaughtering houses (TPH-U). Parameter evaluation was determined based on the Indonesian national standard SNI 01-6160-1999 and the veterinary control certificates which consisted of eight aspects of GMP and six aspects of SSOP. The categorization was clustered in five levels. The results showed that modern slaughtering houses were categorized into 1st and 2nd level, whilst traditional slaughtering houses were categorized into 2nd and 3rd level. The highest incompliance of GMP in modern slaughtering house was the waste treatment aspect (31%) and in traditional slaughtering house was the cold storage presence aspect (95%). The highest incompliance of SSOP in modern slaughtering house was the sanitation facilities and avoiding cross-contamination aspect (21%) and in traditional slaughtering house was the cleanliness of food contact surface aspect (97%). There are some recommendations for improvement the fulfillment of GMP and SSOP aspects based on the critical parameters. Keywords: chicken meat, Good Manufacturing Practice, modern slaughteringhouse, Sanitation Standard Operating Procedure, standard slaughteringhouses

Introduction In 2017, a national recommendation on multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care was published. In order to monitor the implementation in a hospital-based palliative care unit, a dedicated multidisciplinary working group on MDRO was established. It developed a standard operating procedure and a documentation template (checklist). The aim of the present study is to evaluate the implementation status after one year. Methods A mixed-methods approach was selected. The status of implementation was identified through a survey among staff members. A retrospective routine data analysis was performed. A focus group discussion with members of the working group focused on previous steps, factors conducive to implementation and on remaining problems. Results Almost all (18 out of 20) participants (20 out of 29 eligible staff members) knew the national recommendations. Twelve out of 27 recommendations had a high degree of implementation after one year, another 13 recommendations were seen as at least partly integrated into daily routine. For two recommendations the degree of implementation was rated low: (i) ”Taking into account any additional time constraint imposed by protection and isolation measures when planning for personnel and bed occupancy”, and (ii) ”Facilitating the patient's ability to distinguish and recognize team members and family caregivers”. Working group members reported improvements since the implementation, whilst reporting some uncertainty prevailing among both staff members and visitors. Inhibitory factors were said to include the complexity of the standard operating procedure, inadequate usage and poor usability of the checklist. Behavioural and cognitive barriers such as anxieties related to transmission and the sense of security caused by the routine use of protective clothing were considered to be strong. Improving the checklist and the standard operating procedure as well as anchoring procedures in daily routine were considered to be the next important steps. Discussion The implementation of recommendations is an iterative process and requires the ongoing development of appropriate measures for implementation in the respective institution. A multidisciplinary working group with monitoring tasks is an advantage.

Fasika Berhanu Tola,1 Gizachew Tilahun Anbessa,2 Berhan Begashaw Yikna3 1Curative and Rehabilitative Core Process Section, Dire Dawa City Administrative Health Bureau, Dire Dawa, Ethiopia; 2School of Pharmacy, Faculty of Health Science, Jimma University, Jimma, Ethiopia; 3Department of Pharmacy, College of Health Science, Debre Berhan University, Debre Berhan, EthiopiaCorrespondence: Berhan Begashaw Yikna Tel +251-919-365-179Email berhan.uog1912@gmail.comBackground: Health facilities (HFs) need extensive ranges of anti-tuberculosis (TB) drugs and related TB laboratory commodities (LCs) for diagnosis, prevention, and treatment of TB and multi-drug-resistance (MDR)-TB. This study was aimed to assess anti-TB commodities management performance at public HFs of Dire Dawa city administration, Ethiopia.Methods: A cross-sectional study design in 16 HFs providing TB and MDR-TB related service using quantitative and qualitative method was conducted. Semi-structured questionnaires and observation checklists with logistic indicators assessment tools were used to collect data. We used an in-depth interview and analyzed using a thematic approach. Quantitative data were entered into Epi-Data version 3.1 and transported to SPSS version 20 to analyze the results. Chi-square was used to test the association and a P-value< 0.05 was statistically significant.Results: The majority(13; 81.3%) of HFs used a health commodity management information system. Forty-two (40%) bin cards (BCs) for first line anti-TB drugs were not updated, while 62.5% of BCs were updated for second line drugs. On average, 43% of HFs accurately reported a report and requisition format (RRF) had significant association with the presence of a logistic management information system (LMIS) and standard operating procedure (P=0.019). Of the HFs, 50% had good storage conditions and guidelines (P=0.041). Regimen change (56.3%; P=0.035), receive near expiry (56.3%; P=0.035), and defective practice to first expired-first-out (50%; P=0.007) were reasons for wastages. About 50% and 66.6% of HFs were stocked out for isoniazid 300 mg, rifampicin, isoniazid, pyrazinamide (RHZ fixed dose), and ethambutol 400 mg with a mean stock out duration of 10.8, 18.9, and 70.5 days, respectively. Regimen change (68.8%; P=0.026), low demand (56.3%; P=0.041), and delay to resupply (37.5%; P=0.041) were reasons for stock out of anti-TB commodities.Conclusion: Anti-TB drugs and LCs management performance of the HFs were found to be defective, which was confirmed by unsatisfactory data records, inconstant reports, deprived stock record accuracy, long lead time, high stock out rate, wastages, defective storage conditions, lack of training, and management support. Hence, respective organizations should improve their responsible activities to secure an uninterrupted supply of anti-TB drugs and LCs.Keywords: anti-TB drugs, MDR-TB, laboratory commodities, health facilities, Ethiopia

Care of long-term survivors of allogeneic transplant is known to be variable despite international guidelines and accreditation standards. In 2014 a survey of UK NHS-based adult transplant centres identified significant barriers to delivery of long-term follow-up services. In 2019, we repeated the survey to assess changes over a 5-year period when health service policies had mandated JACIE accreditation incorporating standards for long-term care. Improvements were seen in the number of centres having a dedicated long-term follow-up clinic for allogeneic transplant recipients (52% versus 33%) and a standard operating procedure (88% versus 69%). Inclusion of psychological support in standard operating procedures remained low at both time points (32% versus 28%). There was ongoing variation in practice regarding vaccination programmes, access to cancer screening, and audit processes between centres. Perceived barriers to implementation of comprehensive long-term follow-up clinics were similar in 2019; mainly resourcing clinical staff and psychological support. Whilst the survey reflects the changing practice of transplant centres, best explained by increasing recognition of late effects and survivorship by clinicians, health service policy and JACIE accreditation standards, further developments are warranted to address unmet healthcare needs of long-term HSCT survivors, especially access to psychological support, cancer screening and vaccinations.

Introduction Surgical wound care requires an interprofessional approach; however, there is considerable variation in practice and a lack of robust evidence to guide clinicians. Thus, it is important to identify priority areas from the perspectives of end-users to target efforts to both generate and implement high quality evidence. Objective To rank the top four priority questions in wound management across two health districts to inform future research and implementation efforts in wound care. Methods A multisite modified nominal group technique was used to build consensus. Two interactive two-hour workshops were held across two health services districts. Participants were recruited from nursing, allied health and medicine. In preparation for the workshops, a standard operating procedure was developed, and 25 wound care priority questions identified, a priori. Descriptive statistics were used to analyse workshop data. Results Across districts, 38 health professionals participated in the workshops. From a list of 25 clinical questions, the top 10 were determined, and from these, the top four. The number one priority question identified by 23/38 (60.5%) participants across districts related to patients’ understanding/knowledge of their wound treatment. The number two priority question 15/38 (39.5%) participants voted on focussed on patient involvement in wound care. Conclusions Overall, the priority questions reflect the need to encourage patient participation in wound care. These wound care priorities can be used to inform future research and improvement efforts in wound care.

Background There is limited evidence available identifying best practices to promote and sustain optimal outpatient-to-inpatient handoff processes to ensure safe and reliable continuity of care. Local problem A sentinel event occurred during the transition of care from the outpatient-to-inpatient setting. A root cause analysis revealed that the facility's standard operating procedure for patient handoffs was not consistently followed. Methods A Lean Six Sigma approach was used to improve patient transfer with the implementation of a Situation-Background-Assessment-Recommendation handoff policy. Inferential and statistical process control methods were used to assess performance outcomes pre- and postdissemination. Results Over 36 months there was a slow, steady decrease in patient transfer time including reduced variability. The most significant improvement effect occurred in the third year with a 50% reduction in transfer time. Conclusions Longitudinal monitoring provides the opportunity to accurately identify beneficial outcomes, which develop downstream from initial quality improvement efforts.

The pandemic coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern affecting human health and economy across the world. The outbreak in India is accelerating even after enforcement of lockdown as well as promotion of hand hygiene, respiratory etiquettes and social distancing mainly due to nonavailability of specific antiviral medicine and vaccine. Historically, for the purpose of prevention and treatment, homoeopathy has shown its usefulness in recent and past epidemics using carefully selected medicines as genus epidemicus (GE) for each epidemic. In the present era of evidence-based medicine, usefulness of therapeutic agent as prophylaxis is recognised only after obtaining significant result in prophylactic clinical trial. Claims of usefulness of certain homoeopathic medicine as prophylaxis or GE of COVID-19 can be used to generate research hypothesis and can be tested through prophylactic clinical trial. In this article, outbreak investigation procedures are highlighted, necessity of epidemic preparedness with engagement of community is emphasised, several recent developments in clinical trial regulations for an outbreak are pointed out, among which online submission of research protocol, expedition of ethical review procedure, virtual meeting of the ethics committee, Good Participatory Practice Guidelines for Trials of Emerging (and re-emerging) Pathogens are mentioned. Standard operating procedures are discussed to conduct a comparative effectiveness research using cluster randomisation in a multidisciplinary approach to investigate the effectiveness of the homoeopathic medicine as a prophylaxis for COVID-19 which can be used by the policy makers as an effective public health intervention to stop transmission and prevent community spread of this highly infectious disease.

Introduction Peripheral neuropathy represents a spectrum of diseases with different etiologies. The most common causes are diabetes, exposure to toxic substances including alcohol and chemotherapeutics, immune-mediated conditions, and gene mutations. A thorough workup including clinical history and examination, nerve conduction studies, and comprehensive laboratory tests is warranted to identify treatable causes. First steps The variability of symptoms allows distinguishing characteristic clinical phenotypes of peripheral neuropathy that should be recognized in order to stratify the diagnostic workup accordingly. Nerve conduction studies are essential to determine the phenotype (axonal versus demyelinating) and severity. Laboratory tests, including genetic testing, CSF examination, nerve imaging, and nerve biopsy, represent additional clinical tests that can be useful in specific clinical scenarios. Comments We propose a flow chart based on five common basic clinical patterns of peripheral neuropathy. Based on these five clinical phenotypes, we suggest differential diagnostic pathways in order to establish the underlying cause. Conclusions The recognition of characteristic clinical phenotypes combined with nerve conduction studies allows pursuing subsequent diagnostic pathways that incorporate nerve conduction studies and additional diagnostic tests. This two-tiered approach promises higher yield and better cost-effectiveness in the diagnostic workup in patients with peripheral neuropathy.

Objective Creating an environment that supports conditions of routine clinical practice and enables an effectiveness trial design with a pre-licensed medicine is extremely challenging. Here, we summarise our experiences and achievements with engaging and mobilising community pharmacies in and around Salford, United Kingdom, in the Phase III effectiveness Salford Lung Studies (SLS). Methods This article provides the authors’ personal experiences and viewpoints on community pharmacy involvement in the SLS. Key findings More than 130 community pharmacies were enabled, and >2500 pharmacy staff trained, for involvement in the SLS. Key to community pharmacy participation in the SLS was the formation of the SLS Pharmacy Steering Group (PSG), contributing to study oversight, and the development of a pharmacy standard operating procedure document, the major principle of which was to ensure minimum disruption to the normal medicine dispensing process while ensuring compliance with regulations, guidelines, good clinical practice and requirements for pharmacovigilance. The high level of commitment and collaboration of community pharmacy in the SLS demonstrated a willingness to work together and take on additional and novel roles beyond their everyday commercial functions for the benefit of patients, despite normally competing for prescription business. Conclusions The involvement and integration of community pharmacy as a key partner in the SLS was pivotal in securing the delivery of these world-first clinical effectiveness studies. To our knowledge, this has not been previously achieved in a study of a pre-licensed maintenance therapy for a common disease in primary care.

Urinary tract infections (UTI) represent actual form of healthcare-associated infections. The main risk factor of UTI is bladder catheterization. Currently, there are not valid and systematic data on the frequency of atheter-associated urinary tract infections (CAUTI) in Russia, because standard case determination for the official registration is not being used and, consequently, no full-scale records and registration of this nosological form is being maintained. Research objective: to estimate incident rate and potential risk factors of UTI in patients when making bladder catheterization in the urology department at the multidisciplinary clinic for adults. In the course of diagnostic and treatment process it has been determined that bladder catheterizations ratio among all indoor patients amounted to 49,6%; in 2,3% of cases intrusive procedure was carried out urgently in the form of a single urine drainage; the overwhelming majority of catheterized patients were men – 61,5%; catheterization of 9,7% of patients has been lasted for more than 7 days; 48,5% of catheterized patients were individuals of 60 years old and over. According to retrospective analysis data with the use of standard case determination it was found out that CAUTI case rate amounted to 10,68 (95% CI 7,08–14,28) per 100 patients; stratified index of CAUTI incidence amounted to 32,86 per 1000 patient-days of catheterization (95% CI: 21,66–44,06). Epidemical process of CAUTI is characterized by high intensity, predominance of S. epidermidis. The result of the work was the development of a standard operating procedure for setting up a urethral catheter, which includes 8 stages of epidemiologically safe catheterization of the bladder. The proposed SOP on catheterization focuses on individual actions that require mandatory implementation and control.

Coronavirus disease-19 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged in Wuhan, China, in late 2019 It resulted in a worldwide pandemic, and spread through community transmission in the Republic of Korea (ROK) In the ROK, SARS-CoV-2 is categorized as a first-degree infectious disease of the legal communicable disease present The Korean Society for Legal Medicine (KSLM) is the sole official academic association of forensic professionals in the ROK As such, this society has played an important role in forensic medicine and science in the ROK Therefore, KSLM suggests a standard operating procedure for the postmortem inspection in a focus on COVID-19 This article includes the background of this suggested standard operation procedure, basic principles for postmortem inspections of individuals suggested of having an infectious disease, and specific procedures according to the probability level of SARSCoV- 2 infection

Cardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting. This article systematically reviews the literature on cardiac arrest secondary to accidental hypothermia and provides recommendations in addition to a novel algorithm to aid the responding prehospital clinician in deciding if a hypothermic resuscitation standard operating procedure should be implemented.

Background Although diagnostic error (DE) is a significant problem, it remains challenging for clinicians to identify it reliably and to recognize its contribution to the clinical trajectory of their patients. The purpose of this work was to evaluate the reliability of real-time electronic health record (EHR) reviews using a search strategy for the identification of DE as a contributor to the rapid response team (RRT) activation. Objectives Early and accurate recognition of critical illness is of paramount importance. The objective of this study was to test the feasibility and reliability of prospective, real-time EHR reviews as a means of identification of DE. Methods We conducted this prospective observational study in June 2019 and included consecutive adult patients experiencing their first RRT activation. An EHR search strategy and a standard operating procedure were refined based on the literature and expert clinician inputs. Two physician-investigators independently reviewed eligible patient EHRs for the evidence of DE within 24 hours after RRT activation. In cases of disagreement, a secondary review of the EHR using a taxonomy approach was applied. The reviewers categorized patient experience of DE as Yes/No/Uncertain. Results We reviewed 112 patient records. DE was identified in 15% of cases by both reviewers. Kappa agreement with the initial review was 0.23 and with the secondary review 0.65. No evidence of DE was detected in 60% of patients. In 25% of cases, the reviewers could not determine whether DE was present or absent. Conclusion EHR review is of limited value in the real-time identification of DE in hospitalized patients. Alternative approaches are needed for research and quality improvement efforts in this field.

PURPOSE: We update the prior standard operating procedure for magnetic resonance imaging of the prostate, and summarize the available data about the technique and clinical use for the diagnosis and management of prostate cancer. This update includes practical recommendations on the use of magnetic resonance imaging for screening, diagnosis, staging, treatment and surveillance of prostate cancer. MATERIALS AND METHODS: A panel of clinicians from the American Urological Association and Society of Abdominal Radiology with expertise in the diagnosis and management of prostate cancer evaluated the current published literature on the use and technique of magnetic resonance imaging for this disease. When adequate studies were available for analysis, recommendations were made on the basis of data and when adequate studies were not available, recommendations were made on the basis of expert consensus. RESULTS: Prostate magnetic resonance imaging should be performed according to technical specifications and standards, and interpreted according to standard reporting. Data support its use in men with a previous negative biopsy and ongoing concerns about increased risk of prostate cancer. Sufficient data now exist to support the recommendation of magnetic resonance imaging before prostate biopsy in all men who have no history of biopsy. Currently, the evidence is insufficient to recommend magnetic resonance imaging for screening, staging or surveillance of prostate cancer. CONCLUSIONS: Use of prostate magnetic resonance imaging in the risk stratification, diagnosis and treatment pathway of men with prostate cancer is expanding. When quality prostate imaging is obtained, current evidence now supports its use in men at risk of harboring prostate cancer and who have not undergone a previous biopsy, as well as in men with an increasing prostate specific antigen following an initial negative standard prostate biopsy procedure.

The recently published Standard operating procedure: transition to recovery for the resumption of dental treatment in England may prove to be not only the blueprint for the resumption of face-to-face treatments, but also a possible catalyst for change. Seemingly, the raison d'être of the new standard operating procedures is not just to outline the detailed procedures for kick-starting dentistry, but also to support practices through transition and the shift towards a preventative and minimally invasive clinical approach that meets the current clinical challenges, and possibly then goes beyond. Detailed guidance is also provided throughout the document, including the provision and type of required personal protective equipment and clinical guidelines.

Introduction: The emergence of multidrug-resistant bacterial strains is a severe global health issue, which is worsened by the inability of new antibiotics. Virulence inhibition is one of the novel strategies that have been proposed to combat bacterial pathogens more effectively, without the risk of exerting selection pressure on these microorganisms. Inhibition of bacterial cell-cell communication (quorum sensing; QS) is a promising approach however, rapid and cost-effective screening for compounds with QS-inhibitory activity is not yet well-established. Aims: The aim of the present study is to determine the ideal experimental conditions for the disk-diffusion based QS-inhibitory assay with the most frequently used QS-signal molecule-producing and reporter strains. Methods: In our study, the effects of growth characteristics, incubation time, temperature and the used culture media were studied on the used bacterial strains and results of the disk-diffusion based QS-inhibitory assay. Results: Based on our results, the ideal experimental setting includes a modified Luria-Bertani medium (LB*; complemented with nutrients and microelements), incubation at room temperature (25 °C) for 48 hours before the reading of results, where the density of the starting inocula has less influence of the results of the assay. Conclusion: Establishing standard operating procedures (SOPs) is a way to help carry out various operations, aiming to increase precision and efficiency. Adherence to the experimental settings defined based on our results may aid in improving the reproducibility, comparability and reliability of results obtained by this method.

At present, there are no reliable data to identify the number of patients who present for infertility investigations and who are current users of illicit drugs. Therefore, the full extent of this problem remains hidden. Estimates can be made on the basis of population use, although this lacks rigour. The use of illicit drugs can impact on infertility investigations, treatment, welfare of the child and parenting. Furthermore, it can result in serious legal sanctions, including imprisonment. There does not appear to be consistent practice across HFEA licenced clinics in either requiring: (i) the addicted patient to have a specified drug-free period before commencing investigations; or (ii) all patients to be routinely screened. As well as describing the extent of illicit drug use in the UK population, and therefore in those who present in clinic, this paper will discuss screening and encourages debate across clinics regarding a mandatory drug-free period and the development of an appropriate Standard Operating Procedure.

BackgroundAssessment and control of preanalytical handling of blood samples for future research are essential to preserve integrity and assure quality of the specimens. However, investigation is limited on how quality control of preanalytical handling of blood samples is performed by biobanks.MethodsA questionnaire was sent to all Danish departments of clinical biochemistry, all Danish departments of clinical immunology, the Danish Health Surveillance Institution and the Danish Cancer Society. The questionnaire consisted of questions regarding preanalytical handling of samples for future research. The survey was carried out from October 2018 until the end of January 2019.ResultsA total of 22 departments (78%) replied, of which 17 (77%) performed preanalytical quality control of the blood samples. This quality control consisted of patient preparation, temperature surveillance of freezers, maintenance of centrifuges, and visual inspection for hemolysis, lipemia, and sample volume. Automated sample check for hemolysis, icterus, and lipemia interferences was performed by 41% of respondents, not performed by 50% of respondents, and 9% did not answer. The majority (55%) of the participants stated that they had no local standard operating procedure for preanalytical handling of samples for research projects.ConclusionsThe preanalytical phase for blood samples obtained and preserved for future research in Denmark is highly heterogeneous, although many aspects (e.g., hemolysis, which also affects DNA analyses, metabolomics, and proteomics) seems highly relevant to document. Our findings emphasize the need to optimize and standardize best practices for the preanalytical phase for blood samples intended for use in future research projects.

Background There is limited information on the best practices for monitoring multicountry epidemiological studies. Here, we describe the monitoring and evaluation procedures created for the multicountry Severe Typhoid Fever in Africa (SETA) study. Methods Elements from the US Food and Drug Administration (FDA) and European Centre for Disease Prevention and Control (ECDC) recommendations on monitoring clinical trials and data quality, respectively were applied in the development of the SETA monitoring plan. The SETA core activities as well as the key data and activities required for the delivery of SETA outcomes were identified. With this information, a list of key monitorable indicators was developed using on-site and centralized monitoring methods, and a dedicated monitoring team was formed. The core activities were monitored on-site in each country at least twice per year and the SETA databases were monitored centrally as a collaborative effort between the International Vaccine Institute and study sites. Monthly reports were generated for key indicators and used to guide risk-based monitoring specific for each country. Results Preliminary results show that monitoring activities have increased compliance with protocol and standard operating procedures. A reduction in blood culture contamination following monitoring field visits in two of the SETA countries are preliminary results of the impact of monitoring activities. Conclusions Current monitoring recommendations applicable to clinical trials and routine surveillance systems can be adapted for monitoring epidemiological studies. Continued monitoring efforts ensure that the procedures are harmonized across sites. Flexibility, ongoing feedback, and team participation yield sustainable solutions.

Performing a diagnostic lumbar puncture is an essential clinical skill for the clinician. The procedure is of high importance for both, the emergency care for patients with suspected infection of the cerebral nervous system or subarachnoidal hemorrhage, as well as the elective diagnostic work up of chronic disease including multiple sclerosis and dementia. Furthermore the technique’s principles are applied for spinal anesthesia or the intrathecal administration of drugs. This article describes a Standard Operating Procedure for the lumbar puncture step by step. Based on the latest evidence, it particularly focusses on clinically relevant questions and practical aspects.

Perinasia's Kangaroo Mother Care (KMC) training could improve the competence of health officers' knowledge and skills. Both trying the module and evaluating its results are important. Aim This study aimed to assess the skills of neonatal nurses one year after KMC training in the Pasar Rebo District General Hospital. Method A qualitative approach that included in-depth interviews, group discussions, and observations of the neonatal nurses’ skills in KMC was implemented. Thematic analysis was performed. Results A year after follow-up, there was neither KMC training nor a clear policy. It was mentioned that there was a standard operating procedure (SOP) of KMC and routine transfer of health personnel. However, there were no KMC IEC materials or free KMC gowns to support the training. Conclusion The development of KMC services in the hospital not only provided training for health personnel but also required continuation, a clear policy, a SOP, and education support materials.

Feed intolerance and necrotising enterocolitis (NEC) are challenges while treating sick neonates. These can be reduced by giving human milk, but adequate availability of mother’s own milk or pasteurised donor human milk (PDHM) is a challenge in neonatal setups, like ours, without an attached human milk bank. Hence, this quality improvement initiative was taken to improve donor human milk collection in our urban tertiary-care teaching hospital, to at least 500 mL per week in 4 weeks. After analysing the problem, our quality improvement team identified a shortage of human milk donation that was due to low awareness among the stakeholders and lack of a system to collect and store human milk and transport it to a milk bank. The team first established a system of supplies needed for milk collection, storage and transportation. It then tested change idea of information, education and counselling to increase milk donation. The team carried out a few plan-do-study-act cycles (individual and group counsellings, and usage of videos and information leaflets) to test the change ideas and adapted a few and abandoned some. During this journey, the milk collection increased to above the target amount. Various challenges were addressed, and there was a need for constant motivation of the stakeholders, especially the mothers, and now there is sustained milk donation in the setup. This is incorporated in the standard operating procedure and as a quality indicator of the unit for sustaining the changes in the unit. Our initiative can be replicated in other setups for increasing collection of donor human milk. Greater PDHM availability for sick neonates will, in effect, reduce NEC and feeding intolerance rates, leading to reduced hospital stay, morbidity, mortality and economic burden.

BackgroundLack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months.MethodsAll nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded.ResultsSignificant improvement was seen in compliance to various components—use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate’s sickness level.ConclusionsUsing a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.

Background Vector-borne diseases (VBDs) impact both human and veterinary medicine and pose special public health challenges. The main bacterial vector-borne pathogens (VBPs) of importance in veterinary medicine include Anaplasma spp., Bartonella spp., Ehrlichia spp., and Spotted Fever Group Rickettsia. Taxon-targeted PCR assays are the current gold standard for VBP diagnostics but limitations on the detection of genetically diverse organisms support a novel approach for broader detection of VBPs. We present a methodology for genetic characterization of VBPs using Next-Generation Sequencing (NGS) and computational approaches. A major advantage of NGS is the ability to detect multiple organisms present in the same clinical sample in an unsupervised (i.e. non-targeted) and semi-quantitative way. The Standard Operating Procedure (SOP) presented here combines industry-standard microbiome analysis tools with our ad-hoc bioinformatic scripts to form a complete analysis pipeline accessible to veterinary scientists and freely available for download and use at https://github.com/eltonjrv/microbiome.westernu/tree/SOP. Results We tested and validated our SOP by mimicking single, double, and triple infections in genomic canine DNA using serial dilutions of plasmids containing the entire 16 S rRNA gene sequence of (A) phagocytophilum, (B) v. berkhoffii, and E. canis. NGS with broad-range 16 S rRNA primers followed by our bioinformatics SOP was capable of detecting these pathogens in biological replicates of different dilutions. These results illustrate the ability of NGS to detect and genetically characterize multi-infections with different amounts of pathogens in a single sample. Conclusions Bloodborne microbiomics & metagenomics approaches may help expand the molecular diagnostic toolbox in veterinary and human medicine. In this paper, we present both in vitro and in silico detailed protocols that can be combined into a single workflow that may provide a significant improvement in VBP diagnostics and also facilitate future applications of microbiome research in veterinary medicine.

Background Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer post-surgical wound infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff which poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment. Methods We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data was supported by an interview survey with surgeons and nurses. Results The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews confirmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants. Conclusion As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programmes. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is more suitable for resource-constrained rural surgical environments.

Background The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. Methods Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. Results In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0–79.5%) and a specificity of 84.9% (95%-CI: 82.6–87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4–26.5%); specificity, 100% (95%-CI: 100–100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1–78.0%) and a specificity of 83.5% (95%-CI: 81.0–86.0%). Conclusions State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

Background Viruses influence global patterns of microbial diversity and nutrient cycles. Though viral metagenomics (viromics), specifically targeting dsDNA viruses, has been critical for revealing viral roles across diverse ecosystems, its analyses differ in many ways from those used for microbes. To date, viromics benchmarking has covered read pre-processing, assembly, relative abundance, read mapping thresholds and diversity estimation, but other steps would benefit from benchmarking and standardization. Here we use in silico-generated datasets and an extensive literature survey to evaluate and highlight how dataset composition (i.e., viromes vs bulk metagenomes) and assembly fragmentation impact (i) viral contig identification tool, (ii) virus taxonomic classification, and (iii) identification and curation of auxiliary metabolic genes (AMGs). Results The in silico benchmarking of five commonly used virus identification tools show that gene-content-based tools consistently performed well for long (≥3 kbp) contigs, while k-mer- and blast-based tools were uniquely able to detect viruses from short (≤3 kbp) contigs. Notably, however, the performance increase of k-mer- and blast-based tools for short contigs was obtained at the cost of increased false positives (sometimes up to ∼5% for virome and ∼75% bulk samples), particularly when eukaryotic or mobile genetic element sequences were included in the test datasets. For viral classification, variously sized genome fragments were assessed using gene-sharing network analytics to quantify drop-offs in taxonomic assignments, which revealed correct assignations ranging from ∼95% (whole genomes) down to ∼80% (3 kbp sized genome fragments). A similar trend was also observed for other viral classification tools such as VPF-class, ViPTree and VIRIDIC, suggesting that caution is warranted when classifying short genome fragments and not full genomes. Finally, we highlight how fragmented assemblies can lead to erroneous identification of AMGs and outline a best-practices workflow to curate candidate AMGs in viral genomes assembled from metagenomes. Conclusion Together, these benchmarking experiments and annotation guidelines should aid researchers seeking to best detect, classify, and characterize the myriad viruses ‘hidden’ in diverse sequence datasets.

BACKGROUND & AIMS: Hypophosphatemia (HypoP) is associated with organ dysfunction and mortality. Despite its potential severe consequences, HypoP remains poorly characterized in terms of real prevalence and timing of onset. The primary objective was to determine the prevalence of HypoP defined as blood phosphate

9 pags, 2 figs, Isothermal titration calorimetry (ITC) is currently widely used in many applied areas of research, spanning protein-ligand binding, metal-ligand interactions, DNA/DNA or protein/DNA interactions, partition to membranes, and polymer surfactant interactions, to mention just a few. This is due to the availability of commercial instruments, and thus the production and spread of an accepted and widely followed SOP is felt by most users, in an effort to produce results that are scientifically correct and comparable. Therefore, within the efforts of Working Group 4 of the ARBRE-MOBIEU COST Action (CA15126), this ITC SOP was generated, alongside SOPs for several other biophysical techniques. Here, we discuss the factors that are fundamental for good experimental design and that need to be carefully considered, as well as machine calibration, in particular chemical calibration, linked to another outcome of Working Group 4 on ITC benchmarking, to be also published in this Special Issue., M.B. acknowledges the financial support from Fundação para a Ciência e Tecnologia (FCT), Portugal, FEDER through “Programa Operacional Competitividade e Internacionalização” (POCI), UIDB/00081/2020. MB gratefully acknowledges the support of Frederico Silva of the Biochemical and Biophysical Technologies Scientific Platform of the Instituto de Investigação e Inovação em Saúde, I3S, Universidade do Porto. A.V.C. acknowledges financial support from Spanish Ministerio de Economía y Competitividad (BFU2016-78232-P). We thank all colleagues that through COST ARBRE-MOBIEU webpage made very useful suggestions for the improvement of the ITC SOP.

Background Data collection consumes a large proportion of clinical trial resources. Each data item requires time and effort for collection, processing and quality control procedures. In general, more data equals a heavier burden for trial staff and participants. It is also likely to increase costs. Knowing the types of data being collected, and in what proportion, will be helpful to ensure that limited trial resources and participant goodwill are used wisely. Aim The aim of this study is to categorise the types of data collected across a broad range of trials and assess what proportion of collected data each category represents. Methods We developed a standard operating procedure to categorise data into primary outcome, secondary outcome and 15 other categories. We categorised all variables collected on trial data collection forms from 18, mainly publicly funded, randomised superiority trials, including trials of an investigational medicinal product and complex interventions. Categorisation was done independently in pairs: one person having in-depth knowledge of the trial, the other independent of the trial. Disagreement was resolved through reference to the trial protocol and discussion, with the project team being consulted if necessary. Key results Primary outcome data accounted for 5.0% (median)/11.2% (mean) of all data items collected. Secondary outcomes accounted for 39.9% (median)/42.5% (mean) of all data items. Non-outcome data such as participant identifiers and demographic data represented 32.4% (median)/36.5% (mean) of all data items collected. Conclusion A small proportion of the data collected in our sample of 18 trials was related to the primary outcome. Secondary outcomes accounted for eight times the volume of data as the primary outcome. A substantial amount of data collection is not related to trial outcomes. Trialists should work to make sure that the data they collect are only those essential to support the health and treatment decisions of those whom the trial is designed to inform.

An autist refers to a person who suffers from Autism Spectrum Disorder (ASD), a complex disorder of mental development, causing the person to be adversely affected, especially in social and behavioral aspects of life. Prior to the introduction of a specific Standard Operating Procedure (SOP) for the arrest and detention of autists, the Royal Malaysia Police applied the same standard operating procedure in the Criminal Procedure Code for typical individuals, to autists suspected of criminal offences. However, the issue arising is the legal rights of people with disabilities whereby this SOP is seen as inappropriate and unsuitable to be applied to cases involving autists. As a result, the authorities and parties involved in handling autists came up with the idea of the need for a specific SOP applicable for their arrest and detention. Finally, in the year 2019, the Royal Malaysia Police, in cooperation with NGOs directly involved with autist, successfully launched a specific SOP for autists. The objectives of this article are to study the significance of the specific SOP for autists, and analyse and compare it with the usual SOP for typical people. The methodology of this research is qualitative. Collection of research data used document analysis. Data obtained was thematically and comparatively analysed. Research results find that there are differences between the specific SOP for autists and standard SOP for typical suspects. The differences lie in the legal rights of the autists in Malaysia, namely, in the aspects of arrest and detention of autistic suspects.

ZusammenfassungDas Überleben von Schwerverletzten ist von der schnellen und effizienten prähospitalen Versorgung abhängig. Die Zeit vom Unfallereignis bis zum Eintreffen des Patienten im Schockraum konnte leider trotz aller Bemühungen der vergangenen Jahrzehnte und trotz des immer dichteren Netzes an Rettungshubschraubern (RTH), bislang nicht relevant verkürzt werden. Ein gewisser Anteil der Schwerverletzten benötigt bereits prähospital eine Narkoseeinleitung (typischerweise als „rapid sequence induction“, RSI). Durch die medizinischen und technischen Fortschritte der Videolaryngoskopie sowie der im deutschsprachigen Raum eingesetzten Luftrettungsmittel erscheint die Möglichkeit, unter bestimmten Bedingungen die Narkoseeinleitung und das Airway-Management in der Kabine des RTH – also während des Transports – durchzuführen, als mögliche Option, um die Prähospitalzeit zu verkürzen. Für die sichere Durchführung sind die im vorliegenden Beitrag behandelten Aspekte elementar. Beispielhaft wird ein Prozedere vorgestellt, das sich seit geraumer Zeit bewährt hat. Die „in cabin RSI“ sollte allerdings nur von zuvor trainierten Teams bei Vorliegen einer klaren „standard operating procedure“ durchgeführt werden.

Introduction Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units develop delirium, however, it is also frequently observed in non-intensive care unit settings. Risk factors are, among others, older age, brain pathology, severe trauma, orthopaedic or heart surgery, metabolic or electrolyte dysregulations, infections and polypharmacy. The most important measures to prevent and treat delirium are recognition and removal of risk factors and causes. Although delirium is a very common and serious complication, evidence for pharmacological treatment is poor, and guidelines remain controversial. Accordingly, non-pharmacological treatments have gained increasing attention and should be applied. Based on current literature, guidelines and personal recommendations, we developed a standard operating procedure (SOP) encompassing non-pharmacological and pharmacological treatment of delirium. Comments In order to prevent delirium, risk factors should be identified and taken into account when planning the hospital stay and treatment. Prevention should include multimodal non-pharmacological interventions. The treatment of delirium should encompass the elimination of potential causes and non-pharmacological interventions. Pharmacological treatment should be used in a time-limited manner and in the lowest possible dose for the management of highly stressful symptoms or high-risk behaviour. Conclusion The SOP provides a pragmatic algorithm for the non-pharmacological and pharmacological treatment of delirium.

Neuro-oncology biobanks are critical for the implementation of a precision medicine program. In this perspective, we review our first year experience of a brain tumor biobank with integrated next generation sequencing. From our experience, we describe the critical role of the neurosurgeon in diagnosis, research, and precision medicine efforts. In the first year of implementation of the biobank, 117 patients (Female: 62; Male: 55) had 125 brain tumor surgeries. 75% of patients had tumors biobanked, and 16% were of minority race/ethnicity. Tumors biobanked were as follows: diffuse gliomas (45%), brain metastases (29%), meningioma (21%), and other (5%). Among biobanked patients, 100% also had next generation sequencing. Eleven patients qualified for targeted therapy based on identification of actionable gene mutations. One patient with a hereditary cancer predisposition syndrome was also identified. An iterative quality improvement process was implemented to streamline the workflow between the operating room, pathology, and the research laboratory. Dedicated tumor bank personnel in the department of neurosurgery greatly improved standard operating procedure. Intraoperative selection and processing of tumor tissue by the neurosurgeon was integral to increasing success with cell culture assays. Currently, our institutional protocol integrates standard histopathological diagnosis, next generation sequencing, and functional assays on surgical specimens to develop precision medicine protocols for our patients. This perspective reviews the critical role of neurosurgeons in brain tumor biobank implementation and success as well as future directions for enhancing precision medicine efforts.

In order to reduce intrahospital times for stroke patients, we have implemented various strategies throughout the last 4 years. Swift restoration of cerebral perfusion is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be avoided. Therefore management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. In a second step we established a one-stop management of stroke patients, meaning that imaging was acquired with the same angiography suite use for treatment of patients with LVO. In the last section of this chapter we discuss the latest trials on stroke therapy and their implications for our current triage systems and imaging patterns.

This manuscript is intended to give a step-by-step standard operating procedure (SOP) about how to properly conduct a microscale thermophoresis (MST), also known as temperature-related intensity change (TRIC) experiment using the NanoTemper Technology GmbH Monolith instruments.

In contrast to cutaneous melanoma, there are no uniform guidelines regarding surveillance of ocular (uveal, conjunctival) melanomas. A consented standard operating procedure (SOP) by the "Netzwerk onkologische Spitzenzentren" Germany only exists for conjunctival melanoma but not for uveal melanoma. Surveillance is partially based on German S3-guidelines for cutaneous melanoma and is carried out by oncologic centres in a multidisciplinary approach. This study aims to evaluate patients' adherence to surveillance programs and whether surveillance recommendations (examinations, intervals) can be realised.Retrospective analysis of all ocular melanoma patients overseen at the University Hospital of Cologne between 2008 and 2019. The study evaluates rates of successful patient integration into a standardized surveillance program and patients' surveillance adherence, subject to age, gender, primary therapy and tumour entity, respectively.99 patients were included (56 female, 43 male), 83 of which had uveal melanomas and 16 conjunctival melanomas. Mean follow-up was 59 months. 81% of patients were integrated into a surveillance program. Surveillance was performed according to published recommendations in 78%. 13% of patients dropped out of the surveillance program after a mean period of 38 months.Our data show a growing number of patients in standardized surveillance. However, there are still gaps. There is a need for guidelines specifically designed for ocular melanomas, allowing centres to offer patients an individualized approach.Im Gegensatz zum Hautmelanom existieren keine einheitlichen Leitlinien für die Nachsorge bei okulären Melanomen (Aderhaut- und Bindehautmelanome). Lediglich für das Bindehautmelanom gibt es eine konsentierte Standard Operating Procedure (SOP) im Netzwerk onkologischer Spitzenzentren Deutschlands. Die Nachsorge erfolgt i. d. R. in Zentren und dort dann multidisziplinär, teilweise in Anlehnung an die S3-Leitlinie des Hautmelanoms. Ziel dieses Beitrags ist es, die Umsetzung von Nachsorgeempfehlungen (Diagnostik, Intervalle) sowie die Nachsorgeadhärenz okulärer Melanompatienten zu prüfen.Deskriptive, retrospektive Analyse aller Patienten mit Bindehaut- und Aderhautmelanom, die in den Jahren 2008 bis 2019 an der Universitätsklinik Köln betreut wurden. Bestimmt wurde die Rate an erfolgreicher Anbindung an ein strukturiertes Nachsorgeprogramm sowie die Nachsorgeadhärenz, jeweils in Abhängigkeit von Patientenalter, Primärtherapie und Tumorentität.Es wurden 99 Patienten (56 weiblich, 43 männlich) eingeschlossen, darunter 83 Aderhaut- und 16 Bindehautmelanome. Das mittlere Follow-up waren 59 Monate. Eine Anbindung an die interdisziplinäre Nachsorge erfolgte in 81% der Fälle. 78% der Fälle wurden entsprechend den jeweiligen Empfehlungen versorgt. Zu einem Ausscheiden aus dem Nachsorgeprogramm kam es in 13% der Fälle, durchschnittlich nach 38 Monaten.Die Daten zeigen einen zunehmenden Anteil an standardisiert nachkontrollierten Patienten, jedoch noch keine flächendeckende Nachsorge. Es besteht der Bedarf nach Leitlinien, die den okulären Tumorentitäten gerecht werden, um Patienten ein individualisiertes Vorgehen anbieten zu können.

Multicenter Study The EU human biomonitoring initiative, HBM4EU, aims to co-ordinate and advance human biomonitoring (HBM) across Europe. As part of HBM4EU, we presented a protocol for a multicentre study to characterize occupational exposure to hexavalent chromium (Cr(VI)) in nine European countries (HBM4EU chromates study). This study intended to collect data on current occupational exposure and to test new indicators for chromium (Cr) biomonitoring (Cr(VI) in exhaled breath condensate and Cr in red blood cells), in addition to traditional urinary total Cr analyses. Also, data from occupational hygiene samples and biomarkers of early biological effects, including genetic and epigenetic effects, was obtained, complementing the biomonitoring information. Data collection and analysis was completed, with the project findings being made separately available. As HBM4EU prepares to embark on further European wide biomonitoring studies, we considered it important to reflect on the experiences gained through our harmonised approach. Several practical aspects are highlighted for improvement in future studies, e.g., more thorough/earlier training on the implementation of standard operating procedures for field researchers, training on the use of the data entry template, as well as improved company communications. The HBM4EU chromates study team considered that the study had successfully demonstrated the feasibility of conducting a harmonised multicentre investigation able to achieve the research aims and objectives. This was largely attributable to the engaged multidisciplinary network, committed to deliver clearly understood goals. Such networks take time and investment to develop, but are priceless in terms of their ability to deliver and facilitate knowledge sharing and collaboration. Highlights: Feasibility of conducting harmonised Pan-European biomonitoring study on occupational exposure demonstrated; Developing a successful network and implementation of systematic methodology takes significant dedication from all involved; Methodological improvements were identified which will benefit future large-scale occupational biomonitoring campaigns; Developed multicentre network allows and promotes further opportunities for future research, knowledge sharing and collaboration; Data produced supports science to policy interface in the scope of REACH and occupational safety and health regulations. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733032 and received co-funding from the author’s organizations and/or Ministries. info:eu-repo/semantics/publishedVersion