Operative Procedures Research Articles

Penerapan Relaksasi Otot Progresif Terhadap Penurunan Tingkat Kecemasan pada Pasien Luka Kaki Diabetik

Background: Diabetic foot ulcers are one of the most common complications in patients with diabetes mellitus. Patients with diabetic foot wounds have various degrees of anxiety. One of the anxiety measurement tools is HARS (Hamilton Anxiety Rating Scale). Progressive muscle relaxation is one of the non-pharmacological treatments to reduce anxiety. Objective: To describe the results of the implementation of progressive muscle relaxation on anxiety levels in patients with diabetic foot wounds. Methods: This study used a descriptive research design case study approach by observing the anxiety level of diabetic foot wound patients on 2 respondents, carried out in the morning and evening for 5 consecutive days with a frequency of 15 minutes. The instruments used were HARS (Hamilton Anxiety Rating Scale) scale sheet, SOP (Standard Operating Procedure) progressive muscle relaxation, anxiety level observation sheet, stopwatch. Results: Results: There were changes in anxiety levels before and after progressive muscle relaxation in Mrs. S from moderate (27) to mild (15). While in Mrs. I from moderate (26) to mild (15). Conclusion: The application of progressive muscle relaxation can be useful for reducing anxiety levels in both diabetic foot wound patients.

Treatment of anal fistulas with Obsidian RFT®: just another autologous compound platelet-rich fibrin foam?

BackgroundSphincter-preserving techniques like autologous compound platelet-rich fibrin foam have gained popularity, offering potential for better functional outcomes in anal fistula treatment. The present study aimed to evaluate the efficacy and safety of Obsidian RFT®.MethodsThe study conducted a retrospective analysis from January 2018 to December 2022 on patients who received anal fistula closure with Obsidian RTF® at the Department of General Surgery, Medical University of Vienna. Clinical diagnosis, complemented by radiographic imaging, was employed to confirm inconclusive cases.Demographic and fistula characteristics and postoperative data were collected from electronic records following STROCSS criteria.ResultsFifteen patients received Obsidian RFT® treatment for anal fistulas. We found no intra- and postoperative complications. The median hospital stay was 3 days. After a median follow-up of 32 months, a closure rate of 53.3% was detected.Non-significant differences were observed in various variables, yet trends emerged, indicating associations between abscess presence and non-healing fistulas. A distinct age threshold (≥ 42.7 years) served as an indicator for an inability to achieve anal fistula cure.ConclusionObsidian RFT® represents a safe, minimally invasive operative procedure. Approximately half the patients experienced healing, with better outcome in a younger population.Trial RegistrationEthical Approval number Medical University of Vienna (#1258/2018). This study was registered retrospectively in ClinicalTrials.gov (NCT06136325).

Quality Analysis of The Road Widening Project Towards Standards for The Grobogan Road Section - Jember District Limit (Link. 199)

Roads are a land transportation route that has been used since ancient times as a means for people to move places using existing transportation. In road construction efforts, it is necessary to have Standard Operating Procedures, or SOPs, that are used with the aim of improving worker performance, ensuring road quality, increasing profits, and company development. SOP is a method or work flow that has been standardized, is used as binding and directive instructions, and covers things from an activity that has steps or procedures. Currently, there are still many road work projects that are carried out without paying attention to existing SOPs, and this means that the quality of the concrete roads being made does not comply with applicable standards, which means that some parties may experience losses. There needs to be a good understanding of how SOPs comply with standards so that they can produce concrete of maximum quality. This writing was prepared using an analytical method using a literature study that refers to the Indonesian National Standards (SNI) and the PUPR Ministerial Regulation (Regulation of the Minister of Public Works and Public Housing).

Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study.

Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization. This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching. Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614). The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

A Study in Wad Madani, Sudan: Are We Documenting Operation Notes Effectively?

Operative notes represent the critical record of a surgical procedure, encompassing comprehensive details encountered throughout the operation. Recognizing the importance of comprehensive documentation, the Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines, which emphasize accurately recording every procedure and specifying the necessary parameters for each operative note. These guidelines help maintain high standards of surgical care and patient safety. A retrospective review of 88 orthopaedic surgery operative notes for fracture neck of femurs was conducted at Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) from March 12 to May 28, 2022. The review assessed 18 parameters against RCS guidelines.Statistical analysis was performed using Statistical Product and Service Solutions (SPSS,version 25.0; IBM SPSS Statistics for Windows, Armonk, NY), which facilitated comprehensive data examination. In 37 cases (42.05%), the operation notes were written by a medical officer. In 29 cases (32.95%), an orthopaedic resident authored the notes. A specialist documented the notes in 21 cases (23.86%), and a consultant wrote the notes in one case (1.14%). Over 90% of the notes included surgeon and assistant names, procedure names, operative diagnoses, operative procedures, prosthesis details, deep vein thrombosis (DVT) and antibiotic prophylaxis, and signatures. The name of the theatre anaesthetist, elective/emergency details, and additional procedures with reasons were absent in all notes. Less than 50% of the notes documented the time of the procedure, type of incision, operative findings, anticipated blood loss, closure technique specifics, and complications. The study emphasizes the shortcomings in the operating notes, underscoring the necessity for training initiatives to enhance the recording by medical officers and orthopaedic trainees. Implementing structured templates that adhere to RCS standards can improve the comprehensiveness and consistency of operating notes, effectively resolving existing discrepancies. Regular audits and feedback sessions are essential for identifying and rectifying persistent issues. It is recommended to arrange workshops and seminars to educate medical officials and trainees on the skills of efficient note-taking and thorough documentation procedures.

Complications of Laparoscopic and Open Donor Hepatectomy for Living Donor Liver Transplantation: Single Center Experience.

Donor hepatectomy is a major surgery with a relatively safeprofile anda reportedcomplication rate of ~20%. Most complications are non-life threatening and are resolved with conservative measures. However, rare complications may need invasive precautions, ranging from percutaneous interventions to surgeries. We retrospectively analyzed all living donor hepatectomies at our center. Donors were divided into 2 groups: laparoscopic and open procedures. We collected preoperative, intraoperative and postoperative data of donors.Donor complications were recorded separately intraoperatively and postoperatively according to the Clavien-Dindo postoperative complication classification system. Between July 2018 and April 2023, 215 living donors had hepatectomies, including 48 laparoscopic and 167 open donor hepatectomies. Among donors, 91 were female donors (42.3%) and 124 were male donors (57.7%).The meanage of alldonorswas 33.5±8.1 years, and the mean body mass index (in kilogram divided by meters squared) was 24.6 ± 3.8. Among donors, 124 underwent right and 91 underwent left or left lateral hepatectomies. The mean operative time for all donors was 301 ± 83 minutes, the mean hospital stay was 5.8 ± 1.4 days, and the mean follow-up was 31.9 ± 15.8 months. Four patients (1.8%) had intraoperative complications, including 2 cases of bleeding, 1 diaphragm perforation, and 1 portal vein stenosis. Fourteen patients (7.4%) had major postoperative complications, with 5 patients requiring surgical intervention. Donor hepatectomy is a complicated surgery that requires extensive preoperative preparation and appropriate donor selection. Postoperative donor complications can be diagnosed early with close follow-up, and a multidisciplinary approach is essential for complication management.

Recalcitrant Lateral Epicondylitis: A Systematic Review on Current Nonoperative and Operative Treatment Modalities.

Lateral epicondylitis is a common cause of elbow pain that is generally self-limiting. For patients who have persistent symptoms refractory to conservative treatment, there is still no clear consensus on the most favorable treatment modality. The purpose of this systematic review was to synthesize the available literature regarding both nonoperative and operative treatment modalities for recalcitrant lateral epicondylitis (RLE) to provide insight into the efficacy of treatment options. A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, where the PubMed, MEDLINE/Ovid, CINAHL, Cochrane, and Scopus databases were queried to identify studies evaluating treatment options for RLE. A total of 27 studies with 1,958 patients were included. Of the reviewed studies, there were a wide variety of treatments including platelet-rich plasma injections, percutaneous tenotomies, and various arthroscopic and open procedures. There are a wide variety of treatment modalities available for RLE that have promising efficacy in the short, medium, and long terms. A comprehensive approach combining evidence-based and patient-centered care is critical for effective management of refractory symptoms. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcomes in Children Who Undergo Postcardiotomy Extracorporeal Membrane Oxygenation: A Report From the STS-CHSD

BackgroundChildren who undergo cardiac surgery may require postcardiotomy extracorporeal membrane oxygenation (ECMO). Although morbidities are considerable, our understanding of outcome determinants is limited. We evaluated associations between patient and perioperative factors with outcomes. MethodsThe Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for patients aged <18 years old who underwent postcardiotomy ECMO from January 2016 through June 2021. The primary outcome was survival to hospital discharge. The secondary outcome was survival without neurologic injury. Logistic regression for binary outcomes and competing risk analysis for survival were used to identify the most important predictors. Variables were selected by stepwise procedure using entry level P = .35. Those with P ≤ .1 were kept in the final model. ResultsPostcardiotomy ECMO was used to support 3181 patients during the same hospitalization as cardiac surgery: (A) intraoperative initiation of ECMO, n = 1206; (B) early postoperative (≤48 hours), n = 936; and (C) late postoperative (>48 hours), n = 1039. The most common primary procedure of the index operation was the Norwood procedure. Of those with intraoperative ECMO, 57% survived to discharge vs 59% with early postoperative ECMO and 42% late postoperative ECMO (χ2(2) = 64, P < .0001, V = 0.14). In all groups, postoperative septicemia, cardiac arrest, and new neurologic injury had the strongest association with mortality, whereas postoperative reintubation and unplanned noncardiac reoperation were associated with higher survival. ConclusionsMultiple risk factors impact survival in children who undergo cardiac surgery and postcardiotomy ECMO. ECMO initiated >48 hours after surgery is associated with the poorest outcomes. This is the first step in creating a predictive tool to educate clinicians and families regarding expectations in this high-risk population.

A Single Dose of Intrathecal Morphine Without Local Anesthetic Provides Long-Lasting Postoperative Analgesia After Radical Prostatectomy and Nephrectomy

PurposePain after open urological procedures is often intense. The aim of the study was to compare the efficacy of intrathecal morphine with systemic analgesia approaches. DesignProspective, randomized, single-blind controlled study. MethodsPatients undergoing open prostatectomy or nephrectomy were randomly divided into the intervention group or the control group. Patients in the intervention group received morphine 250 mcg in 2.5 mL saline intrathecally. Anesthesia was identical in both groups. All patients were admitted to the intensive care unit (ICU) postoperative and received paracetamol 1 g intravenously every 6 hours and diclofenac 75 mg intramuscularly every 12 hours. If postoperative pain exceeded four on the numeric rating scale, morphine 10 mg was administered subcutaneously. Pain intensity, time to first dose of morphine, morphine doses, and side effects were recorded. FindingsIn total, 41 patients were assigned to the intervention group and 57 to the control group. The time to administration of the first dose of morphine was significantly (P < .001) longer in the intervention group when compared to controls. This observation was also noted individually for patients undergoing nephrectomy (36.86 hours vs 4.06 hours) and prostatectomy (33.13 hours vs 4.5 hours). Many patients did not need opioids after surgery in the intervention group (nephrectomy 72% vs 3%, prostatectomy 75% vs 4.5%, P < .001). There was no significant difference in the incidence of side effects. ConclusionsThe results of our study confirmed that preoperative intrathecal morphine provides long-lasting analgesia and reduces the need for postoperative systemic administration of opioids. Adverse effects are minor and comparable between groups.

Clinical and radiological outcome of surgical hallux valgus correction: open versus minimally invasive

IntroductionHallux valgus (HV) is the most common forefoot deformity. Surgical correction of HV aims to reduce pain, preserve joints, and re-establish foot function while restoring the hallux valgus angle (HVA) and intermetatarsal angle (IMA). Many surgical procedures have been proposed, including open and minimally invasive (MI) techniques. This study aimed to compare the midterm outcomes of open vs. MI procedures and their impact on the duration of surgery, hospital stay, HVA, and IMA post-operatively.Materials and methodsOne hundred and twenty HV patients operated by open or MI surgery between October 2019 and October 2022 were included. One hundred three patients met the inclusion criteria and consented to the study. Patients were prospectively surveyed for foot functionality, post-operative pain, and complications using the AOFAS score. Radiographic measurements of HV angles, length of hospital stay, and surgery duration were analysed.ResultsMI surgery patients had significantly better AOFAS scores (p < 0.001) 12 months post-operatively compared to open surgery. Complication rates were lower in the MI group (3.8% vs. 33.3%, p < 0.001). MI surgery patients also had shorter hospital stays (0.9 ± 0.3 days vs. 2.0 ± 0.0 days) and surgery duration (19.7 ± 2.3 min vs. 80.7 ± 6.8 min). MI surgery was more effective in correcting the IMA but equally effective as open surgery for HVA correction.ConclusionMI surgery resulted in better patient satisfaction, fewer complications, and more precise correction of IMA values. Moreover, the duration of surgery and hospital stay were significantly lower in patients undergoing MI surgery. Further research is needed to validate these findings in controlled, prospective randomised trials.

Outcomes following Arthroscopic Treatment of Off-Track Hill-Sachs Lesions Using Fresh Osteochondral Allograft Plugs: A Case Series

BackgroundOsteochondral allograft (OCA) transplantation is a well-described technique for the treatment of large, engaging Hill-Sachs lesions (HSLs). Traditionally, OCAs are size-matched to the defect, which can be expensive and time-consuming, and the majority of described techniques require an open approach. Recently, an all-arthroscopic approach to Hill-Sachs OCA transplantation using premade plugs was described, eliminating the need for size-matching and graft harvest. Hypothesis/PurposeThe purpose of this study was to evaluate postoperative outcomes of patients who have undergone arthroscopic treatment of HSLs using premade OCA plugs. We hypothesized that these patients would have improved pain and function without recurrent instability. MethodsA retrospective chart review was performed using operative reports for a single surgeon with search terms “Hill-Sachs” and “allograft.” Patients were excluded if an open approach was used or if graft harvest was performed. Postoperative imaging was reviewed to assess for graft incorporation and reconstitution of the HSL. Recurrent instability and reoperation were recorded. Patients completed surveys including the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). ResultsFive patients were identified through chart review and met inclusion criteria. All patients underwent concurrent labral repair and two patients underwent a concurrent open Latarjet procedure. Postoperative radiographs showed reconstitution of the HSLs in all patients. There were no complications in the postoperative period with no recurrent instability or reoperations in any patient. The average ASES score was 87% (higher score indicating better outcome) with standard deviation 9.7, and the average WOSI score was 27% (lower score indicating better outcome) with standard deviation 8.3. ConclusionFavorable outcomes can be expected after arthroscopic treatment of Hill-Sachs lesions using premade OCA plugs. Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches.

Acute rupture of the Achilles tendon : Diagnostics, treatment and aftercare

With up to 50incidents per 100,000 inhabitants, Achilles tendon ruptures are among the most frequent tendon injuries encountered in orthopedics and trauma surgery. Apart from high-risk forms of sport, degenerative processes are primarily responsible for weakening and ultimately rupture. In addition to assessing the typical clinical signs with inability to perform powerful plantar flexion, the diagnostics include easy to earn examination techniques, such as the Thompson test and ultrasound as the imaging gold standard. Conservative and surgical treatment are available depending on the constitution, age and requirements of the patient. The latter option is divided into conventional open, minimally invasive or percutaneous procedures. Good to very good results can be expected regardless of the form of treatment, provided that early functional rehabilitation is carried out. The average rerupture rate is 5% and the return to sport rate is around 80%.

Live agent training as an important process safety measure to strengthen resilience in hazardous (CBRN) work situations.

Various occupational groups as well as emergency responders are important human factors in combating incidents and emergencies in a broad range. Negative deviations from a process-safe condition should be detected and transformed into a safer condition to prevent negative consequences. Therefore, training and education of personnel is an important measure in this case as well as a major influencing factor on the vulnerability to errors during operations and their resilience. From lack of training to incorrect execution due to excessive stress, fear, or unfamiliar situations, it is important to counteract this with targeted training under conditions that are as close to reality as reasonably achievable. Realistic training situations involving live agents allow to recognize mistakes or inadequacies not only in personnel but also in material or in mission planning and to create a more effective working environment. Many violations of work guidelines are due to well-intentioned deviations from nonexecutable standard operation procedures that have never been tested. Repeated, progressive training under real hazardous conditions can help to strengthen mission readiness and resilience of teams. It better prepares them for their dangerous activities.

Hair follicle punch grafts in hard-to-heal wounds: A monocenter study and patient survey.

Chronic wounds present a growing challenge in the aging population, resulting in an extended course of treatment and an increased influx of patients with recalcitrant wounds seeking admission to hospitals. Furthermore, the general trend in patient care is toward simple and inexpensive treatment methods, feasible in an outpatient setting with little material costs. This retrospective case study aims to elucidate the operative procedure and outcomes associated with hair follicle unit transplantation utilizing punch grafts from the scalp for the management of hard-to-heal wounds. A cohort of 28 patients, comprising 20 males and eight females, with a mean age of 72.61 years (range: 48-89) and an average wound area of 82.49 cm2, underwent dissection of punch grafts containing hair follicles (2-3 mm in diameter) from the scalp. Subsequently, these grafts were transplanted into the wound bed. The retrospective evaluation of ulcer healing encompassed photo documentation and clinical records, while patient satisfaction was assessed through structured questionnaires. In 78.6% (22) of the cases, a favorable impact on wound healing was observed, characterized by epithelization, and in 57.1% (16) of the patients, complete wound closure was achieved. With the exception of one donor site, all other sites healed without complications. The patient survey indicated that the majority of individuals subjected to the procedure did not perceive it as painful or time-consuming. Notably, 81% (17) of individuals expressed a willingness to undergo the treatment again. Even in challenging wound conditions, such as pyoderma gangrenosum, our method demonstrated a positive effect on wound healing. Within our cohort, the utilization of hair follicle units in the management of hard-to-heal wounds resulted in either complete or partial wound closure for the majority of patients, accompanied by minimal morbidity, reduced operation time, and a low incidence of complications and associated costs.

Satellite Reference Databases: A literature review of data exchange formats and industrial initiatives

Satellite Reference Databases (SRDBs) aim to manage the definition of telemetry and telecommand objects used by the ground systems to develop satellite operation procedures as well as encode and decode the flow of information between the ground system and the satellite. SRDBs have been identified as a key area of research and industry as they play a major role in the design, operation, and testing of spacecraft. This paper aims to answer research questions about SRDB data exchange formats and SRDB industrial initiatives. To this end, a comprehensive survey of existing research on SRDB has been conducted. To facilitate comprehension of this survey study, a use case is presented to illustrate the various aspects discussed in the literature.

A quality improvement initiative to augment success rate of labour analgesia: interrupted time series analysis

BACKGROUND Standard operating procedures (SOP) for abour analgesia for parturients in Nepal are lacking. Labour analgesia programme was being conducted without a SOP in our institution. We identified that the success rate of epidural labour analgesia (ELA) was low. We developed standard operating procedures for labour analgesia services with the combined effort of the department of anesthesia and pain management with the department of obstetrics and gynaecology in Nepal Mediciti in 2019 January. SOP and troubleshooting protocol was implemented in 2019 February and this study was conducted to investigate the impact of programmed protocol for labour analgesia. METHODS An interrupted time-series analysis was performed as a process improvement project for all cases who demanded labour analgesia from November 2017 to December 2019 with retrospective data collection. The success of epidural labour analgesia was defined as vaginal delivery with Numerical Rating Scale for labour pain of 3 or less. The time series analysis intended to identify the change in the level of success rate (increase or decrease) and change in the slope of success rate over time. RESULTS The major problems identified by the team included lack of patient counselling, inadequate followup after the first dose of epidural, delay in attending call for labour analgesia by the anesthesiologist and undefined clinical pathways for the usage of drugs and troubleshooting. After implementation of the protocol, the interrupted time series showed a 24.77% relative increase in success rate with p value &lt;0.001. CONCLUSION Interdepartmental group discussions, interviews with the patients and development of a team that worked on formulating SOP was done after problem identification. Patient counselling after 28 weeks of gestation gave patients time for psychological preparation and have realistic expectations regarding ELA than labouring parturients. Clear protocol regarding drug dosing and troubleshooting disposed interpersonal variation among the anesthesiologists. Continuous patient follow-up by the nurse-led team helped to identify any additional problems and address it and add on to the protocol. In conclusion, standard operating procedures guided epidural labour analgesia programme enhanced the success rate of epidural labour analgesia.

Implementation of Building Approval Policy in Pasuruan District

This research aims to describe and analyze building approval policies and identify inhibiting and supporting factors in implementing building approvals in Pasuruan Regency. The approach in this research is qualitative research with a descriptive approach. The location of this research is in Pasuruan Regency. The sampling technique used was non-probability sampling, and in determining research, informants used the purposive sampling method. The data collection techniques used were observation, interviews and documentation. For data analysis techniques in this research, Moleong's analysis concept (2021) is used, namely data collection, study and analysis, data reduction, data preparation, data categories, and checking the validity of the data. The results of this research found that socialization regarding building approvals had yet to be carried out by the Pasuruan Regency Government. The disposition or willingness of those implementing the building approval policy in Pasuruan Regency to have the will and compliance to carry out the building approval policy according to standard operational procedures. The building approval service mechanism is by existing SOPs. Coordination in the Pasuruan Regency is all systemized. The internal inhibiting factor is that the server often experiences downtime or maintenance. Meanwhile, external inhibiting factors include the length of time it takes for applicants to return files that need to be revised, the double costs, namely in addition to the levy fees, applicants also have to pay for consultant services, and the unequal distribution of consultants' abilities in consultation sessions. Supporting factors include budget support, clear SOPs, and the placement of their employees in public service malls for building approval services. In the future, the Pasuruan Regency Government should hold its outreach for building approvals, include the outreach in the budgeting for the following year, and be more selective in verifying ..........

Information Management in Hospital Unit Daily Operations: A Descriptive Study With Nurses and Physicians.

Operations management of a hospital unit is a shared activity involving nursing and medical professionals, characterized by suddenly changing situations, constant interruptions, and ad hoc decision-making. Previous studies have explored the informational needs affecting decision-making, but only limited information has been collected regarding factors affecting information management related to the daily operations of hospital units. The aim of this study was to describe the experiences of nursing and medical professionals of information management in the daily operations of hospital units. This qualitative study consists of interviews following the critical incidence technique. Twenty-six nurses and eight physicians working in operational leadership roles in hospital units were interviewed, and the data were subjected to thematic analysis. The data analysis showed that strengths of current systems were organizational operational procedures, general instruments supporting information management, and a digital operations dashboard, whereas opportunities for improvement included the information architecture, quality of information, and technology use. The study findings highlight that despite several decades of efforts to provide solutions to support information management in hospital daily operations, further measures need to be taken in developing and implementing information systems with user-centered strategies and systematic approaches to better support healthcare professionals.

The creation, implementation, and harmonisation of medical standard operating procedures and checklists of Finnish Helicopter Emergency Medical Service units

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

An examination of the use of standard operating procedures on family operated farms

Standard operating procedures (SOPs) can improve farm work organization by ensuring processes are standardized among the different people completing the same task. In this study, we examined the use of SOPs on family operated farms and determined the influence of the number of people working on farm on SOP use. A survey of 315 Irish dairy farms was completed examining the human resource and workload management practices; this study used a subset of questions from that survey. Of the 315 farms surveyed, average herd size was 125 cows and there was 1 other person working with the farmer (range 0 to 5 people). Categorizing farms based on the number of people working on farm, 35% of the farms were owner-operators, 37% had 1 other worker and 28% had 2 or more workers. Overall, 31.3% (n = 98) of all farms surveyed had written SOPs while 68.7% (n = 217) had no written SOPs. Interest in ready-made SOPs among farmers was high (77%). Farms without SOPs found it significantly more difficult to write down work processes and lacked time to create SOPs compared with farms with SOPs. Standard operating procedures most frequently existed for milking (89%), management of fresh cows (35%) and reproduction (29%). Respondents indicated that consistency in work completion was the greatest benefit of having SOPs (39.8%; n = 39), followed by increase in efficiency (17.3%; n = 17) and health and safety (12.2; n = 12). Forty 3 percent of farms with more 3 or more people had significantly more written SOPs present compared with 25% of owner-operator farms and 27% farms with 2 people. This research provides a greater understanding of the use of SOPs on family operated dairy farms, highlighting that the presence of SOPs increases as the number of workers on farm increases.