Standardized Documentation Research Articles

Development of a Human Trafficking Flowsheet for Clinical Forensic Examiners.

When trafficked patients are identified in the healthcare setting, clinical forensic examiners, including sexual assault nurse examiners (SANEs), may be consulted to provide medical care and to collect forensic evidence. However, using a standard sexual assault protocol and documentation form may not completely identify or address the unique needs of these patients. Our SANE program sought to improve the healthcare approach to trafficked patients by developing a trafficking-specific documentation flowsheet. The goal of this quality improvement project was to guide a clinical forensic examiner through a comprehensive examination while addressing specific patient needs and optimizing trauma-informed service delivery. We gathered several local multidisciplinary human trafficking specialists together to provide expert recommendations and feedback during the creation process. Both paper and electronic forms of the flowsheet were designed. SANEs completed the flowsheet on 22 patient encounters and filled out a utilization review survey describing their experience. Feedback data collected through the utilization review process guided further modifications to the flowsheet, which were then implemented into clinical practice guidelines. We found that engaging multidisciplinary specialists and community partners both enhanced the effectiveness of the flowsheet and supported the learning needs of our SANEs. We recommend that clinical forensic programs that wish to develop a similar flowsheet collaborate with local professional agencies to meet the unique needs of the populations within their catchment area and use examiner feedback to maximize the usefulness of the flowsheet.

Implementing ERP with Maintenance and Support in Mind: Exploring the Efficacy of Application Management Services for the Post-Implementation Phase

ABSTRACT Prior ERP research has focused primarily on adoption and implementation; however, in an ERP implementation, maintenance and support (M&S) also has a significant impact on the long-term viability and financial expenditures of organizations. Many organizations turn to application management service (AMS) providers to manage ERP M&S. We surveyed professionals knowledgeable in their companies’ use of AMS for ERP. We find associations between variables consistent with a business case of “keep the lights on” versus “value-driven” partnership and benefits achieved from the arrangement. We also examine activities that should lead to more M&S success: customization, quality documentation, and process standardization. We find associations between some of these variables and (1) more focus on M&S during implementation, (2) challenges transitioning to AMS, and (3) quality of AMS support. Our results are a first step toward research in AMS for ERP M&S and add to the AIS literature on the ERP post-implementation stage. Data Availability: Data available upon request.

A Qualitative Review of the Air Rescue One Rural Search and Rescue Program in British Columbia, Canada.

Rural emergency prehospital care in British Columbia is conducted primarily by the British Columbia Ambulance Services or ground search and rescue volunteers. Since 2014, the volunteer Air Rescue One (AR1) program has provided helicopter emergency winch rescue services to rural British Columbia. The aim of this research was to describe the activity of the AR1 program and to make recommendations to improve future operations. Data were collected retrospectively from September 2014 to May 2021, and parameters of emergency callout statistics from the organization's standard operating guidelines, rescue reports, and interviews were summarized and reviewed. Of 152 missions within the study period, 105 were medically related rescues involving trauma or cardiac events. Snowmobiling, mountain biking, and hiking were the most common activities requiring rescue. The 38 medical callouts that were not completed by AR1 were reviewed for contributing factors. Response time varied due to the vast service area, but median time from request to takeoff was 55 min (interquartile range 47-69 min), and median on-scene time was 21 min (interquartile range 11-33 min). AR1 provides advanced medical care into British Columbia's remote and difficult-to-access areas, minimizing delays in treatment and risk to patients and responders. Callout procedures should be streamlined enabling efficient AR1 activation. Collection of medical and flight information should be improved with standardized documentation, aiding in internal education and future research into the program's impact on emergency prehospital care. Future directions for improvement of care include the possibility of introducing portable ultrasound technology.

Improving Goal-Concordant Care in Intensive Care Unit Admissions from the Emergency Department in a Comprehensive Cancer Center

ContextAs patients approach the end of life, discussion of their treatment goals is essential to avoid unnecessary suffering and deliver care in a manner consistent with their overall values. ObjectivesImplement a multipronged approach to improve the rates of advance care planning (ACP) documentation among providers admitting patients with cancer to the intensive care unit (ICU) from the emergency department (ED). MethodsWe developed multiple interventions including the development of a best-practice advisory to alert providers when patients had previous do-not-resuscitate orders; standardization of ACP documentation; early oncologist involvement in goals-of-care conversations with patients; a survey of ED providers to identify barriers to success; and positive reinforcement strategies aimed at improving the rates of ACP documentation in patients admitted from the ED to the ICU. ResultsPrior to our interventions, only 13% of patients admitted to the ICU from the ED had ACP notes. This percentage increased to 90% by the last month of our project. ConclusionThrough our multipronged approach, we significantly improved the rates of ACP documentation among providers admitting patients from the ED to the ICU.

Implementation of standardized electronic documentation of goals of care discussions to improve cancer care.

11127 Background: Early documentation of physician-led goals of care (GOC) discussions is important to providing comprehensive and individualized quality care to cancer patients as it can provide all members of the patient care team with a context for the type of care each patient wishes to receive prior to and at end of life. The electronic medical record (EMR) should provide easy access to these conversations to seamlessly integrate outpatient, emergency room and inpatient care of cancer patients. Methods: The institution-wide initiative was introduced via presentations and emails between 8/2021 and 11/2021 to all Moores Cancer Center faculty at UC San Diego Health. A SmartPhrase was created in our EMR Epic as the intervention, including critical components of a GOC discussion: people present during discussion, goal of cancer-directed treatment, anticipated cancer trajectory shared with the patient, and patient’s health care agent. The SmartPhrase was radiolabeled to be easily searchable for any clinician accessing the patient’s chart. Physician documentation was tracked for the purposes of achieving a group goal with a target of greater than 50% documentation of GOC discussions within 30 days of the first day of the first cycle of chemotherapy. Prior to physician education, 4% of patients had a GOC note using a searchable SmartPhrase. In 12/2021, we began sending individual emails to physicians to remind them of eligible patients. Results: By 1/2022, after education, 50% of physicians ordering chemotherapy had used the GOC SmartPhrase and 29% of patients initiating chemotherapy had a GOC note using the SmartPhrase. After initiation of monthly reminder emails, documentation increased to 51% by 10/2022. An increased use of Advanced Care Planning billing codes was also noted. Conclusions: Implementation of an initiative to standardize electronic documentation of GOC conversations improved early documentation of these vital conversations. Radiolabeling of the SmartPhrase made it easily accessible to all members of a patient’s care team.

Objective acuity measures for infusion therapy staffing: A predictive model approach—Phase I.

e13553 Background: Acuity is a measure of the complexity of patient care and an estimate of nursing workload. The use of acuity tools is shown to improve care standards, nurse satisfaction and productivity. Existing acuity tools have barriers to adoption, including increased nursing workload, estimate variations among different nurses and clinical care settings, and poor understanding of validity of acuity measures. We aim to build a predictive model for prospectively determining acuity levels and staffing requirements in infusion therapy to address these gaps. This project will be implemented with a phased approach. Here we describe Phase I, to establish a standard measure and documentation process for acuity, then collect and analyze a large data set to quantify the relationship of acuity scores to selected patient characteristics. Methods: A US Oncology Network nursing committee developed evidence-based guidelines for acuity measurement and documentation in August 2023. Nine sites from four independent, community oncology practices were selected to perform acuity rating and documentation using the developed guidelines. Multiple training sessions on the guidelines were conducted with nurses from selected sites. Nurses documented acuity scores (level 1~6) and start time for patients’ infusion visits in the EHR 8/30/2023 – 11/30/2023. Acuity documentation rates were calculated and provided to each site weekly to gain feedback and engagement. Acuity scores were extracted from the electronic health record using natural language processing. Structured data on potential predictors including patient demographics, performance status, lab, and treatment-related information were also collected. Results: A total of 14,610 infusion room visits (5,139 distinct patients) with documented acuity scores were reported. The acuity documentation rate from each site was consistent by week and ranged 60 – 96%. Table reports prevalence of select features by acuity score. Conclusions: An operational workflow was successfully implemented to collect and analyze acuity scores and relevant features. Features of interest include chemotherapy Cycle 1 Day 1, five or more drugs and highly emetogenic treatment. In Phase II, the collected acuity scores and clinical features will be used to build a predictive model to objectively estimate acuity. Phase III will focus on the deployment of the predictive model to oncology practices. [Table: see text]

Subcontractor Engagement in the Two-Stage Early Contractor Involvement Paradigm for Commercial Construction

Commercial construction projects (CCPs) in New Zealand contribute more to the economy than other project types. However, many face cost and time increases due to inadequate planning. Procurement pathways that involve contractors during design development provide more time to plan, collaboratively. Nevertheless, most projects are procured through traditional tender where contractors are only involved after detailed design. Through two-stage early contractor involvement (2S-ECI), contractors can provide design buildability advice for complex projects, contribute value management, carry out exploratory works, and order materials. The role of subcontractors in 2S-ECI can be significant. Six semi-structured interviews were conducted with clients, consultants, main contractors, and a subcontractor involved in large complex commercial construction projects. The findings build on the emerging body of knowledge about 2S-ECI by providing insight into subcontractor early involvement. Project complexity and market conditions were the main reasons for early subcontractor involvement. Common challenges include a lack of information sharing among the parties, non-competitive selection, and a lack of standard contract documentation. Opportunities for improvement include clarifying client expectations, educating stakeholders, and providing more equitable compensation for pre-construction services. Key drivers for subcontractor involvement include project complexity, market conditions, ordering long-lead-time systems, and performance specifications. Specialist early sub-trades include electrical, mechanical, structural steel, and façades. Subcontractors should typically be engaged as early as possible, often concurrently via main contractors to share performance risk. Pre-construction services provided by subcontractors include planning and sequencing; design buildability analysis; risk mitigation; value management; budget advice; systems procurement; design solutions; and document control systems. Advantages include obtaining specialist project knowledge and improving completion certainty. Producing a pre-construction services agreement (PCSA) for subcontractors may address challenges, as has been carried out for main contractors, but there is still a gap in the contractual framework for 2S-ECI for subcontractors.

Acupressure, a promising intervention for fatigue, within the European nursing care pathways (ENP): An integrative review.

The aim of this study is to test whether acupressure for patients with fatigue is an efficient nursing intervention and if it can be implemented into the European nursing care pathways (ENP) nursing classification system. Previously, interventions for acupressure were included nonspecifically in ENP and therefore were not available for standardized nursing documentation in an electronic health record (EHR). Acupressure is a nursing intervention that is increasingly used in specific settings. ENP is a nursing classification system that provides evidence-based nursing interventions for nursing diagnoses. A systematic international literature search was conducted from May 2021 to December 2021. An iterative, hierarchical search process according to the 6S evidence pyramid was chosen. The results were reported following the PRISMA statement. Findings of 49 included publications that studied a total of 1,716 patients indicate that certain acupressure points may be efficient in treating fatigue. Acupressure is a useful nursing intervention and can really help patients experiencing fatigue. It is illustrated how the findings have been implemented in the development of ENP nursing interventions to document acupressure. The acupressure points most frequently used on the ear with positive effects in improving fatigue are Shen Men, liver, spleen, subcortex, endocrine, heart, and sympathetic, while the most common points on the body are ST 36, SP 6, LI 4, HT 7, KID 1, Ex-HN 3, Ex-HN, and KID 3. In the future, nurses will be able to use ENP to quickly and easily document acupressure interventions for fatigue in the EHR. In the EHR, the documentation of the nursing process with ENP could help to promote research into evidence-based approaches to fatigue by generating mass data on the different concepts of acupressure, which could lead to a clearer determination of the evidence and contribute to the safety of care and patients.

Enhancing Procedure Documentation in Neonatal Intensive Care Unit (NICU): A Quality Improvement Initiative at a Tertiary Neonatal Hospital.

Background Accurate and comprehensive procedure documentation in Electronic Medical Records (EMR) is crucial for high-quality patient care, especially in high-acuity settings like Neonatal Intensive Care Units (NICU). Gaps in documentation at Corniche Hospital's NICU that were affecting patient safety and continuity of care were identified and addressed by following a pre and post-intervention design in the research. The process involved the initial audit, educational sessions with healthcare providers, and follow-up audits to measure improvements.Results post-intervention showed a significant increase in compliance with documentation standards, pointing out the effectiveness of educational interventions in improving EMR documentation practices. The local problem is demonstrated through the observation ofincomplete and inconsistent procedure documentation in the NICU,hindering effective patient management and multi-disciplinary team communication. Methods A Quality Improvement Project (QIP) was implemented, including a baseline audit, educational interventions targeting healthcare providers, and subsequent re-audits to assess improvement. The project involved tailored educational sessions focused on correct EMR usage, adherence to documentation standards, and practical aspects of documenting procedures. Results Post-intervention, there was a significant increase in documentation compliance. The percentage of compliance in procedure encounter placement in EMR increased from 81% to 100%, and nursing documentation compliance improved from 11 (52.4%) to 18 (85.7%). However, a slight decrease in the completeness of physician documentation was noted. Conclusions The QIP effectively improved procedure documentation in the NICU. Continuous education and periodic review are essential for maintaining and further enhancing documentation standards. This initiative underscores the importance of targeted training and consistent audits in improving clinical documentation in healthcare settings.

Development and implementation of an evidence-based biofield therapy standardized documentation tool

IntroductionBiofield therapy (BT) is a complementary health practice involving the use of subtle energy to promote healing; however, monitoring the quality of care after implementing a BT program can be particularly challenging. The aim of this project was to strategically design, implement, and evaluate an evidence-based BT documentation tool to capture relevant data elements to display in a quality metric dashboard, while also being satisfactory to the practitioners who use it. MethodsUtilizing the Consolidated Framework for Implementation Research (CFIR) method, key stakeholders at a government healthcare facility were gathered to design and use a structured documentation tool. After the tool's deployment, the stakeholders were routinely assessed over a three-month period to evaluate its effectiveness and identify areas for improvement. At the end of the period a practitioner satisfaction questionnaire was deployed and a quality metric dashboard was launched. ResultsSeven of the eleven BT-trained practitioners (64 %) used the template during the evaluation period and 255 sessions were documented. Forty-five percent of the staff responded to the Likert scored satisfaction questionnaire with 100 % indicating the template improved documentation, fit into the workflow, and facilitated interdisciplinary communication. The dashboard presented nine data elements, such as session indication and patient symptom scores, which can be filtered by date and location. DiscussionThe satisfaction scores validated findings from the literature relative to structured documentation, quality review, and program evaluation. These outcomes support the expansion of BT into different clinical settings, foster future BT research endeavors, and allow for BT to be included in broader medical data analytic efforts. ConclusionA structured documentation tool designed with findings from the evidence and input from key stakeholders can be an effective and satisfactory means of capturing quality metrics for evaluating the implementation of BT.

Assessment of Decision-Making Capacity in 97 Hospitalized Patients With Cancer: A Call for Standardization

BackgroundHospitalized patients with cancer face pivotal decisions that will affect their cancer care trajectory and quality of life, but frequently lack Decision Making Capacity (DMC). Standardization is conspicuously missing for inpatient oncology teams and for Consultation-Liaison psychiatrists performing DMC assessments for patients with cancer. This study sought to characterize a single institutional experience of psychiatric consultations to assess DMC. MethodsWe conducted a retrospective chart review of ninety-seven consecutive psychiatric consultations for DMC from 2017-2019. Demographic, hospital-based, and psychiatry consult differences were assessed based on the reasons for DMC evaluation (uncertainty, patient refusal, emergency) and whether patients had decisional capacity. ResultsOut of 97 consultations, 56 (59%) hospitalized patients with cancer were unable to demonstrate capacity. Consultations came from medical services almost exclusively. Only 5% of primary teams documented their own DMC evaluation. Only 22% of DMC evaluation by C-L psychiatrists documented four determinates of DMC. Few commented on reversibility or tenuousness of DMC, and the identification of agents/surrogates; however, psychiatry consultants were more likely to follow up on patients without DMC. One-third of patients died in the hospital and two-thirds of patients were deceased three months after the consult. ConclusionsGiven the substantial heterogeneity in the documentation of DMC evaluations in this retrospective chart review, we call for more rigor and standardization in documentation of DMC evaluations.

Obstetric Anal Sphincter Injury Management at a Tertiary Academic Birthing Center: A Quality Improvement Initiative [ID 2683441

INTRODUCTION: As a quality improvement project, we implemented an evidence-based management protocol to optimize outcomes after obstetric anal sphincter injuries (OASIS). The aim was to evaluate compliance with practice guidelines for antibiotic use, standardized surgical technique and documentation, utilization of a bowel regimen, and short-term outpatient follow-up after a resident educational OASIS program. METHODS: An OASIS practice guideline was implemented via a curriculum utilizing didactics and simulation with porcine sphincter models to demonstrate primary prevention, proper diagnosis, repair technique, documentation, and post-procedure OASIS management. Pre (August 2018 to July 2022) and post-intervention (August 2022 to July 2023) cohorts were compared for characteristics and provider adherence to guidelines. We used control charts, chi-squared, and Student's t-tests to estimate the effect of the intervention. RESULTS: Among 226 OASIS cases, 168 were pre-intervention and 58 were post-intervention. Proper documentation of OASIS repair increased from 13 (7.7%) pre-intervention to 24 (41.4%) post-intervention (risk ratio [RR] 7.57; 95% CI, 4.3–13.1); proper antibiotic use increased from 79 (47.0%) pre-intervention to 39 (67.2%) post-intervention (RR 1.42; CI, 1.12–1.18); and utilization of bowel regimen increased from 147 (87.5%) to 56 (96.6%) post-intervention (RR 1.1; CI, 1.02–1.18). There was no change in close follow-up appointment attendance (81.0% for both groups; P=.98). Control charts showed a process change in bowel regimen use and OASIS documentation, but no significant change in antibiotic use or close follow-up appointments. CONCLUSION: Implementation of an evidence-based management guideline was associated with increased compliance with evidence-based practices. Future improvement cycles are necessary to optimize outpatient follow-up after OASIS.

Electronic medical record system for school dental hygienists: a preventive focus

Relevance. Clinical documentation remains a cornerstone of medical practice. Over the last decade, there has been a notable evolution in the standards for medical documentation and the speed of processing due to advancements in healthcare information technology, including electronic medical record systems. Despite the Ministry of Health of Russia endorsing specific documentation procedures for healthcare organizations, pediatric preventive care dental services have not yet been provided with an appropriate electronic documentation format.Materials and methods. The development of the electronic medical record system for dental hygienists employed Qt Creator software (http://www.qt.io/), using the C++ programming language framework (http://www.isocpp.org/). The system's efficacy was evaluated through testing across the Omsk region over the period 2020-2021.Results. The project resulted in the successful creation of an electronic medical record system designed for dental hygienists.Conclusion. The new electronic medical record system is set to greatly improve the effectiveness of primary preventive care for dental specialists.

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review.

Older adults residing in residential aged care facilities (RACFs) often experience substandard transitions to emergency departments (EDs) through rationed and delayed ED care. We aimed to identify research describing interventions to improve transitions from RACFs to EDs. In our scoping review, we included English language articles that (a) examined an intervention to improve transitions from RACF to EDs; and (b) focused on older adults (≥65 years). We employed content analysis. Dy et al.'s Care Transitions Framework was used to assess the contextualization of interventions and measurement of implementation success. Interventions in 28 studies included geriatric assessment or outreach services (n = 7), standardized documentation forms (n = 6), models of care to improve transitions from RACFs to EDs (n = 6), telehealth services (n = 3), nurse-led care coordination programs (n = 2), acute-care geriatric departments (n = 2), an extended paramedicine program (n = 1), and a web-based referral system (n = 1). Many studies (n = 17) did not define what "improvement" entailed and instead assessed documentation strategies and distal outcomes (e.g., hospital admission rates, length of stay). Few authors reported how they contextualized interventions to align with care environments and/or evaluated implementation success. Few studies included clinician perspectives and no study examined resident- or family/friend caregiver-reported outcomes. Mixed or nonsignificant results prevent us from recommending (or discouraging) any interventions. Given the complexity of these transitions and the need to create sustainable improvement strategies, future research should describe strategies used to embed innovations in care contexts and to measure both implementation and intervention success.

E021 Patient initiated follow-up long term condition pathway audit

Abstract Background/Aims In October 2022 we created a PIFU Long Term Condition (PIFU-LTC) pathway for our department in line with guidance issued by GIRFT for rheumatological patient initiated follow-up. Entry and exclusion criteria for the pathway were agreed by clinicians. Entry criteria included presence of a relevant diagnosis and established disease (≥ 12-month duration). Exclusion criteria included significant cognitive impairment and/or communication difficulties. Guidance regarding documentation standards, follow- intervals and responses to patient contacts were formalised in the standard operating procedure. We undertook an audit of the pathway to evaluate successes and identify areas for improvement. Methods Between 3/10/22 and 30/3/2023 520 patients had been added to the pathway. A random sample of 10% (n = 52) were audited. Data was extracted onto a bespoke data collection proforma. Data collected included: entry and exclusion criteria for the pathway, current medications, subsequent flares and time to review. Results 33 female and 19 male patients were audited. 86% (n = 45) were of White ethnicity. Mean age was 61 (range 20-83). 81% (n = 42) of patient diagnoses met entry criteria for the pathway. Other diagnoses included osteoarthritis, gout and undifferentiated arthralgia. 92% (n = 48) joined ≥12 months since initial diagnosis. 1 patient had significant cognitive difficulties. Documentation regarding information provision was poor. 40% (n = 21) of patients had no record of being provided a PIFU-LTC information leaflet. 33% (n = 17) had no documentation regarding action to take in case of a flare. 15% (n = 8) of patients had contacted the department since entering the pathway (range 21 to 288 days after joining). 6 of these patients reported a disease flare. Duration between patient contact and telephone review by a clinician ranged between 1- 3 days. 4 patients were also offered a face-to-face clinic appointment, with a range of 2-22 days from first contact until this review. As of October 2023, only 3 patients had been taken off the PIFU pathway. Conclusion This audit had highlighted successes, included the numbers of patients moved onto the pathway and limited inclusion of patients meeting exclusion criteria. Key areas for improvement include improving documentation standards in clinic letters, ensuring adequate information provision to patients and reducing delays to face-face clinic follow up. Further development of the pathway may include expansion of the pathway to other diagnostic groups. Disclosure J. Ellis: None. C. King: None. A. Loganathan: None. R. Sengupta: None.

Development of Standards for Metadata Documentation in Citizen Science Projects

Introduction: Citizen science has generated large volumes of data contributed by citizens in the last decade. However, the lack of standardization in metadata threatens the interoperability and reuse of information.Objective: The objective was to develop a proposal for standards to document metadata in citizen science projects in order to improve interoperability and data reuse.Methods: A literature review was conducted that characterized the challenges in metadata documentation. Likewise, it analyzed previous experiences with standards such as Darwin Core and Dublin Core.Results: The review showed a high heterogeneity in the documentation, making interoperability difficult. The analyzes showed that standards facilitate the flow of information when they cover basic needs.Conclusions: It was concluded that standardizing metadata is essential to harness the potential of citizen science. The initial proposal, consisting of flexible norms focused on critical aspects, sought to establish bases for a collaborative debate considering the changing needs of this community.

ARE NEUROVASCULAR CHARTS APPROPRIATE FOR DIAGNOSING COMPARTMENT SYNDROME?

IntroductionCompartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network.Materials & MethodsAll major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded.ResultsA response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1st webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts.ConclusionsIn 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network.

A template for creating and sharing ground truth data in digital forensics.

Ground truth data (GTD) is used by those in the field of digital forensics (DF) for a variety of purposes including to evaluate the functionality of undocumented, new, or emerging technology and services and the digital traces left behind following their usage. Most accepted and reliable trace interpretations must be derived from an examination of relevant GTD, yet despite the importance of it to the DF community, there is little formal guidance available for supporting those who create it, to do so in a way that ensures any data is of good quality, reliable, and therefore usable. In an attempt to address this issue, this work proposes a minimum standard of documentation that must accompany the production of any GTD, particularly when it is intended for use in the process of discovering new knowledge, proposing original interpretations of a digital trace, or determining the functionality of any technology or service. A template structure is discussed and provided in Appendix S1 which sets out a minimum standard for metadata describing any GTD's production process and content. It is suggested that such an approach can support the maintenance of trust in any GTD and improve the shareability of it.

Critical test result management at Danish hospital laboratories: a national survey

Critical test results in clinical laboratories are crucial for timely patient care, serving as indicators of potentially life-threatening conditions. Despite their importance, a notable heterogeneity in management practices exists globally. This study investigates the current practices of managing critical results at Danish clinical biochemistry laboratories and identifies areas prone for improvement. A comprehensive online survey was distributed to all 21 Danish clinical biochemistry laboratories regarding their critical result management, including documentation practices, critical limit selection, and quality assurance measures. A total of 17 laboratories (81%) responded. The answers revealed a generally uniform approach to managing critical results, with all laboratories having 24-h reporting, local instructions and using the telephone as communication channel. However, variations were noted in documentation practices and critical limit selection. Notably, 23.5% of the laboratories reported that one out of every ten critical results was not reported, indicating a significant risk of delayed critical results. This is further complicated by the limited use of predefined timeframes for reporting and also, only few laboratories actively monitored response times. The findings emphasize the need for more standardized documentation and evaluation practices to align with international standards and to enhance patient safety. While the laboratories showed a commitment to standardized procedures, the study emphasizes the necessity of a National or Nordic guideline to supplement the ISO 15189:2022. This study is a step towards optimizing critical result management, not only in Danish clinical biochemistry laboratories but also across various laboratory specialties, thereby improving overall laboratory quality, efficiency, and patient safety.

Development of Malaysian Science Standard Document for Teaching Year Four Student according to Neoteric Approach Curriculum: A Concept Paper

Purpose: This paper discussed about the development of Neoteric Approach Curriculum concept and the mapping of the Science Standard Document. The objectives of study are to examine the benefits of integrated curriculum, to outline the mapping of the concept of Neoteric Approach Curriculum for Year Four and to discuss the significant of integrating Science, Health Education and Visual Art.
 Methodology: The development of the Neoteric Approach Curriculum for Year 4 Science Standard Document was generated from the idea of subject-integration. The mapping of the integration of Science, Health Education and Visual Art are needed to originate an integrated discipline that named as Learning Cluster of Human Development for Year Four. This learning cluster is grouped based on the intention to improve human personal development in terms of skills development and academic knowledge. 
 Findings: The Neoteric Approach is a new and modern approach for delivering the teaching and learning process that helps to strengthen the existing Malaysian National Curriculum. Neoteric Approach Curriculum acts as a solution to the modernization of education and pedagogy to produce a holistic student in terms of balanced physically, emotionally, spiritually and intellectually, as well as to be competitive to fulfil the needs of 21st century. The theories that supported the concept of Neoteric Approach curriculum are constructivism theory by Jean Piaget and progressivism theory by John Dewey. Based on the theories, the elements that emphasized are active learning and learning by doing which allows the students to learn by actively engage in the learning process and enhanced their learning experience.
 Unique contribution to theory, practice and policy: By having this approach, it could help to enhance the students-centred learning with integrated strategy and support active learning in classroom, cultivating students’ knowledge and skills development which will benefit them in the future.