Formal Documentation Research Articles

PROVA DA CONDIÇÃO DE SEGURADO ESPECIAL PARA ACESSO À APOSENTADORIA RURAL: DESAFIOS E PERSPECTIVAS NO CONTEXTO JURÍDICO BRASILEIRO

The present study aims to analyze the challenges and perspectives related to proving the condition of special insured status for access to rural retirement in Brazil. The study investigates the obstacles faced by rural workers in producing such proof, identifying the main associated judicial demands. Specifically, it seeks to understand the requirements for the granting of rural retirement in Brazilian law, identify the main challenges for proving rural worker status in both administrative and judicial contexts, and analyze judicial decisions and official documents to observe how the courts have addressed the issue. It was found that the absence of formal records, such as workbooks or contracts, is a factor that contributes to legal uncertainty and the denial of rights to these workers. Judicial decisions have played a fundamental role by adopting a more flexible stance in accepting testimonial evidence and alternative documents, aiming to ensure that rural workers are not penalized for the lack of formal documentation. However, there are still significant gaps between legislation and the reality faced by these workers, highlighting the need for more inclusive public policies to ensure full access to social security rights.

Rhythms of Tradition Explores the Rich Heritage of Folk Music and Dance in Western Odisha

This study explores the rich heritage of folk music and dance in Western Odisha, delving into its cultural, spiritual, and social significance. Western Odisha is home to folk traditions such as Ghumura, Danda, Leela, Dhap, Sankirtan, and Daskathia, all of which reflect the region's deep historical and religious roots. These performances are not merely artistic expressions but serve as vehicles for transmitting cultural knowledge, reinforcing community bonds, and maintaining religious and spiritual practices. Instruments like Ghudka, Sarangi, and Devgunia are integral to these performances, symbolizing identity and tradition. The study reveals that many of these traditions are tied to religious rituals and agricultural cycles, with performances occurring during specific festivals or times of the year. Furthermore, the research highlights the role of these folk traditions in social functions, particularly in promoting community cohesion and facilitating courtship among youth. However, the influence of modernization, coupled with a lack of formal documentation, poses challenges to preserving these traditions. The increasing popularity of classical dance forms like Odissi in the region adds to the cultural transformation. The discussion emphasizes the need for institutional support and more excellent documentation to preserve these folk traditions for future generations. Festivals, workshops, and financial support for folk artists are proposed as potential solutions to safeguard this intangible cultural heritage. In conclusion, while the folk music and dance of Western Odisha continue to thrive, proactive efforts are essential to protect and sustain these traditions in the face of modern challenges.

Improvising the Malware Detection Accuracy in Portable Document Format (PDFs) through Machine Learning Classifiers

Every time a spike is observed in cyber-attacks, a huge financial loss is incurred that has surpassed $2 trillion according to some estimates. Apart from monetary setbacks, the damages in terms of loss of credibility and quality of services are way more difficult to recover. PDF documents have been considered as innocuous source of data sharing with static meta-tags. However, the structure of PDF file contains different objects, features and characteristics that make it easier for the attackers to invade (by attaching the malicious code with tags). Current research is focused on analyzing the structure of PDF files, data-structures exploited and extracting feature tags with associated feature values of PDFs. A total of 17,884 documents were used, having two categories (8942 malicious documents and 8942 benign files).

Hip Fracture Management in a Major Trauma Centre: The Impact of 'Smart Phrase' Integration Into Electronic Clerking on Culture and Adherence to Guidelines.

The National Institute for Health and Care Excellence (NICE) introduced guidelines in 2011 for the management of hip fractures in patients over the age of 65. NICE CG124 recommended different procedures depending on the demographics of the patient and fracture pattern. In terms of compliance in 2019, Addenbrooke's Hospital (ADH) was found to be in line with the national average, although room for improvement was noted. The aim of this study was to identify and address areas of substantial non-compliance at ADH. A total of 1636 patients who sustained a hip fracture between 2017 and 2020 and who subsequently underwent surgery at ADH were retrospectively analysed. We collected data from the National Hip Fracture Database (NHFD), digital medical records, and digital imaging systems. We then amended the clerking proforma by adding a 'smart phrase' and re-analysed another 543 patients who attended ADH following hip fracture between 2021 and 2022, using the same data collection methods. From 2017-2020, total adherence to CG124, Section 1.6, was 76.04%. Our results demonstrated that 56.43% of all hip fracture patients indicated for total hip arthroplasty (THA) did not have documented consideration for the procedure. In 2021-22, following the addition of our 'smart phrase,' we made to the clerking proforma, total adherence improved to 87.43%, with only 42.11% of THA-indicated patients lacking documented consideration of the procedure, down from 65.41% in 2020. The use of our smart phrase decreased during the follow-up without a corresponding drop in compliance. In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated. However, we have demonstrated that we can increase NICE guideline compliance by standardising and encouraging formal documentation of the decision-making process. As electronic patient record (EPR) systems become more widespread, we have shown how 'smart phrases' can be used to generate change and increase compliance, even over a short period of time.

A Review on a Drug Registration Process in United Kingdom

This review outlines the regulatory modifications in several pharmaceutical industries that have been impacted by Brexit and develops new standards-based recommendations from the Medicines and Healthcare Products Regulatory Agency (MHRA). To get insight into the regulatory changes that occurred in the pharmaceutical industry during the dissolution of Europe and Britain, retrospective and contemporaneous reviews were used. As the transition period concluded, the MHRA issued a library of new guidelines on January 1, 2021. The several pharmaceutical industries covered by this guidance include clinical trials, medical equipment, imports and exports of Pharmaceuticals and Cosmetics. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for approving medicinal products in the UK. The agency offers various routes for marketing authorisation, including national, international, and decentralised procedures. The national routes include a 150-day assessment, rolling review, European Commission (EC) Decision Reliance Procedure, decentralised and mutual recognition reliance procedure, and unfettered access procedure for marketing authorisations approved in Northern Ireland. International routes include Project Orbis and Access Consortium. Applicants must submit their applications through the MHRA submissions portal in electronic Common Technical Document (eCTD) format. The agency verifies the technical validity of submissions using the Lorenz Docubridge validation tool. The MHRA offers fast-track marketing authorisation for products with strong public health benefits or those addressing supply shortages. Applications that do not meet guidelines will be rejected, and applicants must resubmit after correcting errors. Understanding MHRA guidelines and requirements facilitates market entry for medicinal products in the UK. Conclusion: Any medicinal agent to be marked in the United Kingdom has to follow the guidelines and regulations given by the MHRA a regulatory authority which approve drug products. The objective of the review article is to highlights information regarding the requirements. Different types routes in registration of medicinal products in a market in the United Kingdom knowing the requirements of the MHRA guidelines, it is too easy for a product to get into the UK market.

WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit

Abstract Aim Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes. Methods A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover. Results At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients >65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%. Conclusion Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.

A task‐centric knowledge graph construction method based on multi‐modal representation learning for industrial maintenance automation

AbstractMaintenance manuals are crucial information sources for maintenance and repair. Prior studies explored factual knowledge extraction from textual documents. However, maintenance knowledge in manuals is more task‐centric rather than factual knowledge and often documented in an unstructured Portable Document Format (PDF), posing challenges for knowledge extraction. Addressing this, this research develops effective methods to extract task‐centric maintenance knowledge from unstructured PDF manuals. A new Task‐centric Knowledge Graph (TCKG) schema centralized on maintenance task components (MTCs) is proposed to address the need for structured knowledge representation. A method (Heterogeneous Graph‐based Method, HGM) for knowledge extraction is then proposed, which is enhanced by incorporating visual and spatial information. In the experiments, the proposed HGM exhibits robust performance in the knowledge extraction process, surpassing the baseline Graph‐based Interaction Model with a Tracker (GIT) method in MTCs extraction by 13.3%, and the baseline Translate Embedding (TransE) method in MTCs' relation extraction by 3.8%. A series of ablation studies also prove that including visual and spatial information through the proposed method can improve the relation extraction performance by over 10%. This research supplies valuable insights for future developments in information extraction from maintenance manuals.

Algorithms or biomarkers in patients with lower DGBI?

Several organizations have proposed guidelines or clinical decision tools for the management of patients with disorders of gut-brain interactions (DGBI) affecting the lower digestive tract including irritable bowel syndrome and chronic idiopathic constipation. Such algorithms are based on sequential therapeutic trials and modifying the treatment strategy based on efficacy and adverse events. The aims of this review are to evaluate the evidence for efficacy of second- and third-line pharmacotherapies and to assess the evidence for the alternative option to manage subgroups of patients with symptoms suggestive of lower DGBI based on diagnostic tests or documented dysfunctions. The preeminent tests to identify such subgroups that present with symptoms that overlap with lower DGBI are detailed: digital rectal examination as well as anorectal manometry and balloon expulsion for evacuation disorders, detailed measurements of colonic transit, and diagnosis of bile acid diarrhea or carbohydrate malabsorption based on biochemical measurements. The review also addresses the cost implications of screening to exclude alternative diagnoses and the costs of therapy associated with the therapeutic options following an algorithmic approach to treatment from the perspective of society, insurer, or patient. Finally, the costs of the diagnostic tests to identify actionable biomarkers and the evidence of efficacy of individualized therapy based on formal diagnosis or documentation of abnormal functions are detailed in the review.

ResumeCraft: A Machine Learning-powered Web Platform for Resume Building

Abstract: The competitive job market necessitates well-crafted resumes that resonate with both human recruiters and Applicant Tracking Systems (ATS). This paper introduces ResumeCraft, a web-based platform empowering users to build strong resumes and optimize them for ATS compatibility. ResumeCraft leverages Machine Learning (ML) for data analysis and user guidance, while the user interface is built with Hypertext Markup Language (HTML), Cascading Style Sheets (CSS), and JavaScript for a user-friendly experience. The system allows users to input their personal and professional details through a series of form fields, and provides a real-time preview of the resume design as the user inputs their data. The resume generator uses JavaScript to dynamically populate the preview with the user's input, and allows users to select from a range of pre-designed templates and color schemes to customize the look and feel of their resume. It processes the user input and generates a downloadable Portable Document Format (PDF) of the final resume. The platform analyzes user-provided information through ML models, offering suggestions on skill extraction, keyword matching, and action verb usage. This combination empowers users to create impactful resumes that are more likely to pass through ATS filters and reach human reviewers.

Ancient Sheep Genomes Reveal Four Millennia of North European Short-Tailed Sheep in the Baltic Sea Region.

Sheep are among the earliest domesticated livestock species, with a wide variety of breeds present today. However, it remains unclear how far back this diversity goes, with formal documentation only dating back a few centuries. North European short-tailed (NEST) breeds are often assumed to be among the oldest domestic sheep populations, even thought to represent relicts of the earliest sheep expansions during the Neolithic period reaching Scandinavia <6,000 years ago. This study sequenced the genomes (up to 11.6X) of five sheep remains from the Baltic islands of Gotland and Åland, dating from the Late Neolithic (∼4,100 cal BP) to historical times (∼1,600 CE). Our findings indicate that these ancient sheep largely possessed the genetic characteristics of modern NEST breeds, suggesting a substantial degree of long-term continuity of this sheep type in the Baltic Sea region. Despite the wide temporal spread, population genetic analyses show high levels of affinity between the ancient genomes and they also exhibit relatively high genetic diversity when compared to modern NEST breeds, implying a loss of diversity in most breeds during the last centuries associated with breed formation and recent bottlenecks. Our results shed light on the development of breeds in Northern Europe specifically as well as the development of genetic diversity in sheep breeds, and their expansion from the domestication center in general.

Beliefs and Practices in the Life Cycle of the Agta of Lupigue, North Sierra Madre Mountains: Their Implications to Indigenous Peoples Education

The enactment of the Indigenous Peoples’ Rights Act of 1997 and the legislation of National Commission on Indigenous Peoples Administrative Order No. 1 series of 2012 recognize and promote all the rights of the Indigenous Peoples including the proper documentation of their Indigenous Knowledge Systems and Practices (IKSPs). The absence of formal documentation of their IKSPs is a major issue and is getting increasing attention in the research literature. The ethnographic research was employed to find out the beliefs and practices in the life of the Agta of Lupigue in Sierra Madre Mountains and their implications to education. The Agta still observed some of their beliefs and practices but could hardly explain their existence and persistence. Their observance is more of a sign of respect to their elders and ancestors. These cultural beliefs and practices pose a great challenge to education particularly in its role in social transformation.

Semantics of Power: Written Communication, Formal Documentation and Codified Law in British Malabar

Semantics of Power: Written Communication, Formal Documentation and Codified Law in British Malabar

Developing reinforcement of character education by implementing religious nationalism values

Character education teaches ethical values in society and the state. It included religious nationalism values in the educational curriculum aimed at passing down the norms that apply to the life of a society. This study aimed to analyze the reinforcement of character education by implementing religious nationalism values in the school of Nasima, Method of this research used an ethnographic qualitative design. The research instruments utilized interview, observation, and documentation formats. Data collection was conducted by interviewing the foundation's chairman, school principal, teachers, and parents of students as core informants, and triangulation was carried out by interviewing educational supervisors and the education department of Semarang city. The results of the study revealed that reinforcement of character education by implementing religious nationalism values in the school of Nasima applied role play, exemplifying, the habituation of students to strengthening their good-manner behavioral culture, honesty, discipline, and the formation of religious nationalism character. The realization of education and religious character towards strengthening the values of nationalism can be implemented through four strategies, namely an integrated learning strategy between subjects carried out by teachers in the classroom, parental engagement strategy, school collaboration with society for strengthening the values of religious nationalism and their daily positive behavior through extracurricular activities and a partnership education strategy by involving agencies. government, private sector, religious leaders, and community leaders.

Processing 2D barcode data with metaheuristic based CNN models and detection of malicious PDF files

Portable Document Format (PDF) is a file format created to create portable and printable documents across platforms. PDF files are one of the most widely used application types in computer-based systems. Thanks to the functionality that PDF files provide, they are used by many users around the world. Malware developers can exploit PDF files due to various factors. Malware can integrate embedded files, JavaScript, PDF files, etc. As a result, PDFs are susceptible to security vulnerabilities in computer-based systems. In this study, we utilised the CIC-Evasive-PDFMal2022 dataset, made accessible by the Canadian Cybersecurity Institute in 2022, that includes two categories, namely benign and malicious. In the preprocessing step, the proposed model transformed text-based PDF parameter data into the 2D PDF417 barcode. 2D Convolutional Neural Network (CNN) models (MobileNetV2, ResNet18, and ShuffleNet) are trained using the dataset generated by the preprocessing step. CNN is a type of artificial neural network used in image recognition, processing, and classification. Type/class based feature sets were then obtained by each CNN model. In the last step, the metaheuristic optimization method (Honey Badger Algorithm) was used. Thanks to this method, the best performing feature set was determined among the feature sets of the types extracted from each CNN model. It was then classified by the softmax method, and an overall accuracy of 99.73% was achieved. The proposed approach has successfully trained 1D data with 2D CNNs. In addition, with the barcode imaging technique, direct understanding of the data by the users is prevented.

ОЦЕНКА ПЕРСПЕКТИВ ИСПОЛЬЗОВАНИЯ СЫРЬЯ ТАВОЛГИ В ФАРМАЦИИ И МЕДИЦИНЕ

An analysis of the scientific literature has shown a significant interest of researchers around the world in the study of medicinal plant raw materials and new sources of herbal preparations of various pharmacological effects. One of such promising objects is the vyazolistnaya meadowsweet or labaznik, an unpretentious plant widely distributed on the territory of the Russian Federation. Due to its diverse chemical composition, labaznik has a wide range of properties necessary for the manufacture of various drugs with high pharmacological activity. The main group of biologically active substances of meadowsweet are phenolic compounds. The essential oil has noticeable antimicrobial and antifunginal activity. Today, being a pharmacopoeial plant in the Republic of Belarus, France and the United Kingdom, in the Russian Federation, meadowsweet does not have the appropriate regulatory documentation, which makes it difficult to use this plant as a source of medicines. In addition, the presence of a number of dietary supplements on the pharmaceutical market, which include different types of raw materials of meadowsweet, also requires the availability of appropriate regulatory documents. The pharmacological activity of different types of raw materials has been confirmed in a significant number of studies by scientists from different countries, however, the plant is still of interest for further testing, especially in the Russian Federation for the formation of regulatory documentation. In this article, the authors conducted a systematic analysis of scientific research on the pharmacological activity of various types of raw materials of the labasnik and assessed the prospects for its use in Russian pharmaceutical practice.

Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach

Abstract Introduction In Saudi Arabia, more than 55% of older patients are subjected to potentially inappropriate prescribing.[1] Despite this, deprescribing by healthcare professionals (HCPs; e.g. physicians and pharmacists) is limited. Therefore, identifying barriers to and facilitators of deprescribing from HCPs’ perspective is crucial to establish the evidence base to inform future development of a deprescribing intervention in the hospital setting in Saudi Arabia. Aim To explore HCPs’ experiences and perspectives of deprescribing in older patients in order to identify barriers to and facilitators of deprescribing, using a theory-based approach. Methods A qualitative study using semi-structured interviews conducted with physicians and pharmacists who worked in hospitals in a southern region of Saudi Arabia. A purposive sampling approach was employed to recruit participants from various hospitals with different levels of experience. Physicians who worked with older inpatients and pharmacists with a ward-based role who had input into prescribing decisions were eligible to be included. Theoretical Domains Framework (TDF2)-based interviews were conducted with participants until theoretical data saturation was achieved.[2] Interviews were audio recorded, transcribed verbatim and data analysed inductively using reflexive thematic analysis. Themes were mapped to the TDF2, enabling prioritisation of domains and identification of behaviour change techniques (BCTs) for inclusion in future intervention development. Results Forty HCPs were interviewed (20 physicians and 20 pharmacists). Four themes associated with facilitators and barriers to deprescribing were identified: (i) perceptions and consequences of deprescribing; (ii) roles of HCPs and communication; (iii) factors influencing deprescribing decisions and (iv) culture, environment, and resources. All determinants from these themes were mapped to TDF domains. Six TDF domains were prioritised to represent key barriers and facilitators. These were: the limited role of pharmacists in deprescribing (‘Social/professional role and identity’); lack of formal documentation of deprescribing outcomes (‘Behavioural regulation’); perceived risks versus benefits of deprescribing (‘Beliefs about consequences’); lack of tailored guidelines for deprescribing (‘Knowledge’); lack of a connected system between different hospital settings (‘Environmental context/resources’) and the importance of inter-professional social support and collaboration between HCPs (‘Social influences’). These domains were mapped to 40 BCTs for consideration for inclusion in a deprescribing intervention. Conclusion This study served as a starting point for the design of a theory-based intervention in Saudi Arabia to implement deprescribing in hospital settings. The findings have revealed influences on deprescribing that have not previously been described in this context. These encompassed the need to enhance the interface between primary and secondary care and the potential impact of improving health and social care systems in Saudi Arabia to enable deprescribing. Participants were sampled across a southern region of Saudi Arabia, which enhanced the transferability of the findings to other similar hospital settings. However, only physicians and pharmacists were recruited, which may limit the international transferability of the findings to countries where other professionals have a role in deprescribing. Future work will determine the prioritised BCTs to be operationalised in the intervention using the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria.

Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study.

Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health. We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.

СВОЙСТВА КАЧЕСТВЕННЫХ ТЕСТ-КЕЙСОВ

The properties of high-quality test cases in the formation of technical documentation are presented

761 Transforming Fluid Resuscitation Documentation to Improve Quality Outcomes

Abstract Introduction Accurate and readily available documentation of burn fluid resuscitation is essential for decision-making by the multidisciplinary team during the first 24 to 48 hours of care. Fluid resuscitation documentation in the electronic medical record (EMR) is ideal. However, due to the limitations of the EMR, bedside nurses must navigate to various tabs to document fluids, view orders, document events, review labs, and notify providers. To decrease burden of care and improve the accessibility of accurate fluid resuscitation information, our multidisciplinary team embarked on a journey to create a new format in the EMR for fluid resuscitation with our information technology (IT) department. Methods In April 2022, the burn team initiated discussions to build a new and streamlined process for documentation of fluid resuscitation. The goal was to decrease the amount of navigation in the EMR during fluid resuscitation by the bedside nurse and improve the accessibility of meaningful hourly documentation for the multidisciplinary team. During monthly meetings, a multidisciplinary team of nurses, a pharmacist, educators, and IT professionals collaborated on each component needed to capture the desired detailed documentation of each fluid resuscitation. Results The new format for fluid resuscitation documentation in the EMR is constructed as a navigator flowsheet and initiated in September 2023. The bedside nurse performs all documentation on this one flowsheet. Information from the Lund-Browder calculates initial fluid resuscitation rates and goal hourly urine output. Once the bedside nurse initiates the fluid resuscitation, navigating to any additional flowsheets or tabs in the EMR is unnecessary. Certain information also pulls in automatically from devices, such as vitals, bladder pressure, and urine output. Documentation of hourly fluids infused, vital signs, urinary output, fluids changes, bedside procedures performed, provider notification, nursing notes, and consulting team interventions are all performed in the narrator. The bedside nurse can also access all orders, labs, and notes without navigating elsewhere in the EMR. Real-time documentation using the narrator allows multidisciplinary team access without disrupting the patient’s nursing care. The post-resuscitation report provides hour-by-hour documentation for debriefing and reviewing each fluid resuscitation. Conclusions The development of this new tool has afforded bedside nurses more time spent caring for the patient rather than navigating the EMR. Providers no longer go to the patient room to retrieve information to help guide fluid resuscitation and disrupt patient care. The post-resuscitation report provides an accurate account of the fluid resuscitation period for debriefing and review. Applicability of Research to Practice Our process can be shared with other burn centers hoping to replicate this process.

Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model.

Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient's disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient's place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans' current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans' participation in serious illness care conversations and subsequent EHR documentation. The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. RR1-10.2196/55080.