Procedural Guidelines Research Articles

Rapid design and implementation of a UVC decontamination room

With the recent COVID-19 pandemic that has swept the world and the nation, hospitals around the country have experienced shortages in Personal Protective Equipment, specifically N95 filter face-mask respirators (FFRs). This has created the need for facilities to develop sterilization processes to enable reuse of face masks by the health care personnel. Among the various methods of sterilization, UVC light exposure is the easiest to implement given the factors of time, safety, and availability. Face masks and/or other PPE are exposed to UVC light for a specified time to kill any viruses or bacteria that may reside on the surfaces of the masks. A collaborative effort was formed in April of 2020 between Wellstar Health System and Kennesaw State University to (1) setup an appropriate sterilization room at a Wellstar hospital (2) develop the procedural guidelines necessary to ensure quality control and (3) assess employees’ perceptions of the N95 FFR decontamination process and efficacy. This paper will first describe the methodology used to validate the layout of the room, which consists of a rudimentary analytical analysis of the UVC photon intensity from bulb-to-mask, computer simulations to determine the lighting power density throughout the room, and experimental measurements to confirm the appropriate energy deposition. This paper will then document the procedures for handling and processing the pre- and post-sterilized masks followed by employee survey findings. It is the hope of the authors that this paper will serve to provide a generic blueprint for hospitals and other organizations to follow if a future need arises for rapid UVC decontamination.

Joint EANM/SNMMI/ESTRO practice recommendations for the use of 2-[18F]FDG PET/CT external beam radiation treatment planning in lung cancer V1.0

Purpose2-[18F]FDGPET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies.MethodsA literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO).Results and conclusionThis guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-[18F]FDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.

The spectrum of the atomic energy regulatory board under the department of atomic energy with respect to a medical radiation facility

Increasing medical radiation facility strongly demands to have a dedicated, competent regulatory body for guiding and managing radiation safety, quality, and standardization of rules and regulations to safeguard the human population nature from adverse effects of radiation. In India, we have the Atomic Energy Regulatory Board for managing the medical radiation facility for diagnosis and treatment of medical conditions and also to save them from radiation hazards under the Department of Atomic Energy (DAE), India. The Atomic Energy Regulatory Board (AERB) has launched the e-Licensing of Radiation Application (eLORA), which is an application built on the web-based that establishes a channel of direct communication between the AERB and its stakeholders for information and communication exchanges in terms of providing regulatory services with higher levels of effectiveness, reliability, and transparency. They also provide various radiation awareness programs, advertisements, and radiation safety guidelines for diagnostic and therapeutic procedures. DAE has a very wide spectrum in which the AERB plays a vital role in establishing regulatory processes, activities of radiation facilities such as radiodiagnosis, radiotherapy, and nuclear medicine in medical also create and publish regulatory safety documentation for utilities and consumers along with acts and regulation. Basically, AERB provides the common platform for all the radiation practicing medical institutions through eLORA, which help to streamline the radiation practice toward the betterment of humankind.

Faculty Academic Performance Assessment (FAPA) Model

Academic Performance Assessment is a key institutional process in evaluating academic faculty to ensure quality and maximum output in all key areas of their assigned responsibility. The current paper provides an overview of the Academic Performance standards for higher education faculty in the United Arab Emirates. These standards are set by various educational authorities in the UAE, such as the Commission for Academic Accreditation (Ministry of Education), the National Qualifications Authority, and the private and public higher education institutions of the country. Three key areas of performance are included, namely, Teaching Effectiveness, Scholarly Activities, and Academic and Community Service. The current paper proposes an assessment model addressing these areas and includes: assessment criteria and indicators, rubrics. timeline and procedure guidelines, post-assessment action plan, assessment forms (lesson observation, Academic Dean assessment, faculty action plan assessment, student assessment, final grade).

Antibiotic Use in Cesarean Section and Hysterectomy Procedure: Qualitative and Quantitative Assessment

Antibiotic resistance is global issue and the incident is increasing with the use of unwise antibiotic. This study is to describe and evaluate appropriateness of antibiotic prophylaxis selection on Cesarean Section and Hysterectomy procedure. Purpose of study is to evaluate appropiateness of antibiotic selection on cesarean section and hysterectomy. A retrospective study was performed during September 2016 - January 2017 in Private Hospital, Semarang. Data were analized quantitatively using ATC-DDD methodology. Evaluation of antibiotic prophylaxis will be assessed based on The guideline of The American College of Obstetricians and Gynecologists (ACOG) : Antibiotic Prophylaxis for Gynecologic Procedures and The American Society of Health-System Pharmacists (ASHP) : Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. Overall, 90 of 95 patients were given antibiotic prophylaxis. The most frequently used antibiotics were ceftriaxone (69.51 DDD/Patient-days) and ceftazidime (14.95 DDD/Patient-days). Appropriate antibiotic selection based on the guidelines for cesarean section procedure was 1.75% and 6.1% for hysterectomy procedure. The use of antibiotic prophylaxis on cesarean section and hysterectomy procedure was very high and less appropriate in the selection. Almost patient received third-generation cephalosporin instead of first-generation cephalosporin such as cefazolin. cefazolin is more effective and narrow spectrum for infection-causing bacteria of these procedures.

Stopień doktora praw w okresie dwudziestolecia międzywojennego w Polsce – regulacje prawne oraz postulaty Wydziałów Prawa

Doctor of Law Degree in the Interwar Period in Poland – Legal Regulations and Postulates of the Faculties of Law Several periods can be distinguished in the creation of legal regulations regarding the doctoral degree, including the doctor of laws. The first one, until 1924, was of a transitional nature, the years 1924-1933 were used to develop general, procedural guidelines, and the period after 1933 was to adapt the existing regulations to the new Act on Academic Schools. It should be noted that all legal acts relating to the doctoral degree were consulted with law faculties, and their opinions had a direct impact on the introduced changes.

A Detailed Testing Procedure of Numerical Differential Protection Relay for EHV Auto Transformer

In power systems, the programmable numerical differential relays are widely used for the protection of generators, bus bars, transformers, shunt reactors, and transmission lines. Retrofitting of relays is the need of the hour because lack of proper testing techniques and misunderstanding of vital procedures may result in under performance of the overall protection system. Lack of relay’s proper testing provokes an unpredictability in its behavior, that may prompt tripping of a healthy power system. Therefore, the main contribution of the paper is to prepare a step-by-step comprehensive procedural guideline for practical implementation of relay testing procedures and a detailed insight analysis of relay’s settings for the protection of an Extra High Voltage (EHV) auto transformer. The experimental results are scrutinized to document a detailed theoretical and technical analysis. Moreover, the paper also covers shortcomings of existing literature by documenting specialized literature that covers all aspects of protection relays, i.e., from basics of electromechanical domain to the technicalities of the numerical differential relay covering its detailed testing from different reputed manufacturers. A secondary injection relay test set is used for detailed testing of differential relay under test, and the S1 Agile software is used for protection relay settings, configuration modification, and detailed analysis.

EANM procedure guidelines for brain PET imaging using [18F]FDG, version 3

The present procedural guidelines summarize the current views of the EANM Neuro-Imaging Committee (NIC). The purpose of these guidelines is to assist nuclear medicine practitioners in making recommendations, performing, interpreting, and reporting results of [18F]FDG-PET imaging of the brain. The aim is to help achieve a high-quality standard of [18F]FDG brain imaging and to further increase the diagnostic impact of this technique in neurological, neurosurgical, and psychiatric practice. The present document replaces a former version of the guidelines that have been published in 2009. These new guidelines include an update in the light of advances in PET technology such as the introduction of digital PET and hybrid PET/MR systems, advances in individual PET semiquantitative analysis, and current broadening clinical indications (e.g., for encephalitis and brain lymphoma). Further insight has also become available about hyperglycemia effects in patients who undergo brain [18F]FDG-PET. Accordingly, the patient preparation procedure has been updated. Finally, most typical brain patterns of metabolic changes are summarized for neurodegenerative diseases. The present guidelines are specifically intended to present information related to the European practice. The information provided should be taken in the context of local conditions and regulations.

Analysis of characteristics of electric propulsion systems intended for carrying out maneuvers of maintenance of low Earth working orbit of small satellites

An analysis of the mass of the working fluid and motor operating time of electric propulsion systems applied as a part of small spacecraft to carry out maneuvers of maintenance of the low Earth working orbit is carried out. The analysis is carried out for the small spacecraft with the weight in the range from 300 to 1000 kg functioning in working orbits with the height in the range from 400 to 600 km. When carrying out the analysis the values of the specific impulse of the propulsion system in the range from 800 to 1600 sec were accepted. Procedural guidelines for assessing the value of the required characteristic speed depending on the aerodynamic drag force, as well as for assessing the value of mass of the working fluid with account for the value of the specific impulse and defining the motor operating time of the propulsion system depending on the exhaust speed of the working fluid were used. The results of calculations given in the article show that the mass of the working fluid and the motor operating time vary depending on the height of the orbit and the mass of the small spacecraft and allow making quick preliminary assessment of the main design characteristics of the electric propulsion engines used to carry out maneuvers of maintenance of the low Earth working orbit of small spacecraft with different weight dimension characteristics during the prescribed term of active existence.

Incidence and prevalence of violence toward health care workers in emergency departments: a multicenter cross-sectional survey

BackgroundWorkplace violence and abuse in the emergency department (ED) has increasingly become a serious and alarming phenomenon worldwide where health care professionals are more prone to violence compared with other specialties.AimsWe aimed to estimate prevalence, and types of work place violence made against health care workers (HCW) in emergency departments of Arabian Gulf area.MethodsWe performed a descriptive cross-sectional study at several emergency departments in Saudi Arabia and United Arab Emirates wherein a previously validated questionnaire was distributed among health care workers. The survey consisted of 22 questions that assessed respondent’s workplace violence and/or abuse encounters, protective measures, available work place policies, and actions implemented to detect and deal with violence and abuse against healthcare providers. Descriptive statistics was used and P value < 0.05 was considered significant for all statistical tests performed.ResultsSeven hundred HCW in eleven emergency departments agreed to participate in the survey. Four hundred ninety-two completed the questionnaire with a response rate of 70%. More than 90% of the respondents were in the 20–39 years old bracket with an approximately equal gender distribution. Then, 20.9% of the respondents stated that they were physically attacked and 32.3% were attacked with a weapon. Most of the respondents (75.6%) reported that they were verbally abused or bullied by patients or relatives of patients. Staff responses to emotional abuse varied among respondents with the most frequent response of “told the person to stop” (22%), followed by “took no action” (19%). Further, 83.3% of respondents stated that there was an existing policy and procedure guidelines for reporting work place violence while 30.1% reported that they had not used any of these measures.ConclusionWorkplace violence among HCW in the emergency departments are common in the Gulf area and can be serious in as far as use of weapons. Staff awareness focus on this under reported issue, and staff training to recognize and report potential aggression can predict a significant reduction of incidents.

ФОРМУВАННЯ КОМПЕТЕНЦІЇ ОРГАНУ МІСЦЕВОГО САМОВРЯДУВАННЯ ЯК ОСНОВНА ФЕНОМЕНОЛОГІЯ ДЕЦЕНТРАЛІЗАЦІЇ ПОВНОВАЖЕНЬ ПУБЛІЧНОЇ ВЛАДИ В УКРАЇНІ

The article is devoted to the study of the formation of competence of the local authority selfgovernment as the main phenomenology of decentralization of powers of public authority in Ukraine. The author notes that the world experience and the experience of independent development of Ukraine suggest that the most productive mechanism for uniting society around the fundamental values of civil society is the development of local self-government. The article is devoted to large-scale reform of local self-government, which is aimed at overcoming the centralized Soviet system and the formation of a decentralized system of local government, as well as increasing the powers of self-governing bodies to develop the territories. Some particularly problematic issues have been studied, which significantly hinder the solution of current problems in the field of “competence content” of public authorities. These include the lack of general theoretical definition of competence, lack of scientific understanding of the system of properties of competence, as well as recognition of the existence and formation of their own competence in local governments as self-governing (municipal) public authorities. The author points out that the success of the reform of decentralization of public power in the framework of municipal reform leads to the transformation of the competencies of local governments, especially in the context of forming a block of powers of their own competence and executive bodies. The author of the article offers an ontological and axiological analysis of the sphere of competence of local self-government bodies in its modern sense. It is emphasized that the “alpha and omega” of the competence of local governments should be strategic procedural guidelines that reflect the dependence of the competences of local public authorities on the interests and will of residents of local communities. It is revealed that the system of individual, group and collective interests of a person determines the objectification of the need to form their own competence for local governments. It is a doctrinal conclusion that the process of reforming public authorities is directly related to the process of forming the competence of local governments, which in conditions of decentralization and deconcentration, form their own competence base of powers and subjects. The topical issues of forming the own competence of the local self-government body are given and analysed. The author of the article argues that this process is the main phenomenology of decentralization of public authority in Ukraine. The author’s opinion is substantiated that decentralization is one of the most successful reforms of recent times, but at the same time, some problems of both organizational and applied nature remain unresolved, which negatively affects the prospects of decentralization in Ukraine.

Severe Accident Management Systems and Procedures

A nuclear power plant’s safe operation involves the planning for non-standard operational emergencies, where pre-determined safety measures and damage control interventions must be taken into consideration depending on the developed event. A nuclear power plant’s safe operation involves the planning for non-standard operational emergencies, where pre-determined safety measures and damage control interventions must be taken into consideration depending on the developed event. The definition of the severe accident management cannot be explained in a single concept, it needs to be examined in detail. As a result of this it becomes necessary to specify the procedure guidelines appropriate to the nature of the event, which can be used with optimal efficiency under hierarchical organisational control. The experience of nuclear accidents in the world and the precognition of future events, the knowledge of existing guidelines for severe accident management needs to be deepened continuously, but at the same time it can be parallelly upgraded with the application of new technologies.

Advanced Data Analysis for Fluorescence-Lifetime Single-Molecule Localization Microscopy.

Fluorescence-lifetime single molecule localization microscopy (FL-SMLM) adds the lifetime dimension to the spatial super-resolution provided by SMLM. Independent of intensity and spectrum, this lifetime information can be used, for example, to quantify the energy transfer efficiency in Förster Resonance Energy Transfer (FRET) imaging, to probe the local environment with dyes that change their lifetime in an environment-sensitive manner, or to achieve image multiplexing by using dyes with different lifetimes. We present a thorough theoretical analysis of fluorescence-lifetime determination in the context of FL-SMLM and compare different lifetime-fitting approaches. In particular, we investigate the impact of background and noise, and give clear guidelines for procedures that are optimized for FL-SMLM. We do also present and discuss our public-domain software package “Fluorescence-Lifetime TrackNTrace,” which converts recorded fluorescence microscopy movies into super-resolved FL-SMLM images.

Assessment of Average Hematocrit of Red Cell Units for Erythrocytapheresis Procedure in Sickle Cell Disease

Background:Erythrocytapheresis, or red blood cell exchange (RCE) is a non-invasive procedure in which a patient's erythrocytes are removed from the bloodstream while being replaced with erythrocytes from blood donors. RCE is commonly used as a transfusion technique in patients with sickle cell disease (SCD) to help treat and prevent complications associated with sickling of erythrocytes and iron overload.The AABB consensus report (1) outlines the procedural guidelines for RCE including appropriate indications and ideal forms of vascular access. However, the guidelines make no recommendation for determining the hematocrit (Hct) of the red cell bags for the procedure.Institutions take several different approaches to determine how many red cell units to exchange. The number of units needed depends on the volume and Hct of the individual units as well as the patient's pre-procedure Hct and HbS levels, height, weight, and the desired HbS and Hct targets. Red cell units are routinely labeled with volume, but are not generally labeled with Hct. The AABB consensus report (1) states that some institutions use an estimated Hct of 56% to 57% for each unit. The report rationalizes the use of an estimated Hct for input for the RCE, by citing the approximated Hct of bags of red cells (55% to 60%) with additive solution produced from whole blood donation, based on limited data.The goal of our study was to determine the average Hct on the red cell units used for RCE.Methods:This study used a retrospective chart review to investigate the Hct of red cell units during a RCE in a calendar year. Our institution uses pre-storage leuko-reduced red blood cells units in citrate phosphate dextrose adenine (CPDA-1) and adsol preservative (AS-1), which are 21 days old or less for RCE. The average Hct of the bags of red cells infused during the procedure was determined by accessing each bag for a small sample of blood to determine the Hct. Data was excluded if the patient did not meet standard weight requirements (> 30 kg) or required additional treatment protocols including the use of washed cells or machine priming.Results:A total of 297 encounters were recorded for 30 different patients. A total of 1953 bags (approximately 517 liters of red cell units in volume) were administered. Data from the encounters were used to calculate measures of central tendency. The average calculated Hct for each encounter was 63.3%, with a median and mode Hct being 63% and 62%. The range of Hct from the bags was 54.6% to 72.9%. The average Hct of the bags ranged from 60.6% (in March) to 64.8 % (in July).Conclusions:Our study suggests a higher average Hct of transfused red cell units than stated in the AABB consensus report (1), which was based on limited data. Our findings indicate that a standardized average of 63.3%, would be appropriate for our institution. Conversely, our findings also signify that the standardized average Hct must be determined in each institution prior to their application for RCE. However, our data also reveals that it is possible to subject patients to estimates as far as 9.7% above and 9.6 % below the true average Hct of the red cell bags used. The process of determination of Hct for each of the red cell units increases the time of pre-service activities, laboratory costs, and the overall infusion center time for the patients leading to higher costs per infusion. Consequently, using a standardized average of the Hct would result in cost savings. We have therefore adopted the practice of using the standardized average of Hct of 63.3% for RCE in our patients.Reference:1. Biller E, Zhao Y, Berg M, Boggio L, Capocelli KE, Fang DC, Koepsell S, Music-Aplenc L, Pham HP, Treml A, Weiss J, Wool G, Baron BW. Red blood cell exchange in patients with sickle cell disease-indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB. 2018 Aug;58(8):1965-1972. doi: 10.1111/trf.14806 DisclosuresMunson: Terumo Medical Corporation: Consultancy, Honoraria, Speakers Bureau. Raj: Terumo Medical Corporation: Honoraria, Speakers Bureau; Global biotherapeutics: Speakers Bureau; Forma therapeutics: Consultancy.

Evidence on respectful maternity care for adolescents: a systematic review protocol

BackgroundIntrapartum mistreatment of women is an ubiquitous public health and human rights challenge. The issue reportedly has severe maternal and neonatal outcomes including mortality, and generally leads to a decreased satisfaction with maternity care. Intrapartum mistreatment, despite being ubiquitous, indicates higher incidence amongst adolescent parturients who are simultaneously at a higher risk of maternal morbidity and mortality. Studies have suggested that Respectful Maternity Care interventions reduce intrapartum mistreatment and improve clinical outcomes for women and neonates in general. However, evidence on the effect of RMC on adolescents is unclear. Hence, the specific aim of this study is to synthesise the available evidence relating to the provision of RMC for adolescents during childbirth.MethodsThe methodology of the proposed systematic review follows the procedural guideline depicted in the preferred reporting items for systematic review protocol. The review will include published studies and gray literature from January 1, 1990, to June 30, 2021. Electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science will be searched to retrieve available studies using the appropriate search strings. Studies included in the review will be appraised for quality using tools tailored to each study design. If appropriate, we will conduct random effects meta-analysis of data to summarise the pooled estimates of respectful maternity care prevalence and outcomes. The selection of relevant studies, data extraction and quality assessment of individual studies will be carried out by two independent authors.ResultsSummaries of the findings will be compiled and synthesised in a narrative summary. In addition to the narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for respectful maternity care prevalence and outcomes.DiscussionRespectful Maternity Care for adolescents holds great promise for improved maternal and neonatal care. However, there is a gap in knowledge on the interventions that work and the extent of their effectiveness. Findings from this study will be beneficial in improving Adolescents Sexual and Reproductive Health and Rights and reducing maternal mortality, especially for adolescents.Systematic review registrationPROSPERO CRD42020183440

PET/CT Technology in Adult Zebrafish: A Pilot Study Toward Live Longitudinal Imaging.

Decades of research have confirmed the beneficial and advantageous use of zebrafish (Danio rerio) as a model of human disease in biomedical studies. Not only are 71% of human genes shared with the zebrafish many of these genes are linked to human diseases. Currently, numerous transgenic and mutant genetic zebrafish lines are now widely available for use in research. Furthermore, zebrafish are relatively inexpensive to maintain compared to rodents. However, a limiting factor to fully utilising adult zebrafish in research is not the fish but the technological imaging tools available. In order to increase the utilisation of adult zebrafish, which are not naturally transparent, requires new imaging approaches. Therefore, this feasibility study: (1) presents an innovative designed PET/CT adult zebrafish imaging platform, capable of maintaining normal aquatic physiology during scanning; (2) assesses the practical aspects of adult zebrafish imaging; and (3) set basic procedural guidelines for zebrafish imaging during a PET/CT acquisition.Methods: With computer aided design (CAD) software an imaging platform was developed for 3D printing. A 3D printed zebrafish model was created from a CT acquisition of a zebrafish using the CAD software. This model and subsequently euthanised zebrafish were imaged post-injection using different concentrations of the radiotracer [18F]FDG with CT contrast.Results: PET/CT imaging was successful, revealing levels as low as 0.01 MBq could be detected in the fish. In the zebrafish imaging post-injection distribution of the radiotracer was observed away from the injection site as well as tissue uptake. Potential preliminary husbandry and welfare guidelines for the fish during and after PET/CT imaging were determined.Conclusion: Using PET/CT for adult zebrafish imaging as a viable non-invasive technological tool is feasible. Adult zebrafish PET/CT imaging has the potential to be a key imaging technique offering the possibilities of enhanced biomedical understanding and new translational data sets.

Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up

Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was “symptomatic irreversible pulpitis” with “normal apical tissues.” During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.

Creating a Periop 202 Course and Orientation Program for Open-Heart Procedures to Increase Cardiovascular OR Nurse Recruitment and Retention.

As the global population ages, hospital administrators will need to employ a sufficient number of OR nurses to meet the demands of increasing surgical volumes. However, ORs can be intimidating working environments and undergraduate nursing programs lack formal didactic courses in perioperative nursing, leaving little to entice newly graduated nurses to the perioperative specialty. It is important for nurse leaders to employ interventions for recruiting and retaining OR nurses, particularly in specialty service lines, including cardiovascular surgery. A Periop 202 course for open-heart procedures was developed and woven into a cardiovascular OR (CVOR) orientation program for newly graduated nurses and experienced nurses who were new to the CVOR. The program aimed to increase new CVOR nurses' competencies and knowledge of protocols and guidelines for open-heart procedures and their self-efficacy to function on the CVOR team. Knowledge questionnaire and learning scale results showed increased postintervention knowledge and self-efficacy among program participants.

Acute Toxicity Study of Porang (Amorphophallus oncophyllus) Flour Macerated with Strobilanthes crispus in Wistar Rats

BACKGROUND: Porang (Amorphophallus oncophyllus) is a local tuber food that high in bioactive compound glucomannan. It uses are limited due to oxalate acid content which poses health risks. Strobilanthes crispus leaves could reduce the level of calcium oxalate in porang. However, there is still no study to prove its safety. AIM: This study aimed to investigate the acute oral toxicity study of porang (A. oncophyllus) macerated with S. crispus based on observation of mortality rate (LD50), the changes in behavior during 72 h, renal and hepatic function such as urinary protein, serum glutamic oxaloacetic transaminase (SGOT), and serum glutamic pyruvic transaminase (SGPT) levels of Wistar rat (Rattus norvegicus) METHODS: An acute toxicity test was conducted based on the Organization of Economic Co-Operation and Development 420 Fixed-Dose Procedure Guideline that consists of preliminary and main studies. For the preliminary study, rats were divided into control and five treatment groups with the dosage of 50, 300, 2000, and 5000 mg/kg body weight (BW) for each natural porang flour (NPF) and S. crispus-macerated porang flour (SPF). For the main study, rats were divided into four groups, those were NPF and SPF with the dosage of 2000 and 5000 mg/kg BW. Levels of urinary protein and blood serum SGOT and SGPT levels were measured at 0, 24, and 72 after treatment. RESULTS: The acute toxicity study showed that porang and porang macerated with S. crispus were not toxic until the highest dose of 5000 mg/kg BW. It was proved by the absence of LD50, no change in behavior, no weight losses, and also the results of biochemical tests, such as urinary protein, SGOT, and SGPT which were still in the normal range. CONCLUSIONS: Porang flour and SPF were concluded as non-toxic food based on acute toxicity study.

MP18-13 ENDOUROLOGY FOR STONES DURING COVID-19

INTRODUCTION AND OBJECTIVE: Guidelines for endourological procedures during COVID-19 have suggested to defer nonobstructed stones, while obstructed/ infected stones should be considered emergencies.1,2 In our centre, screening protocols (as per Ministry of Health's guidelines)3 were implemented with prioritization strategies so that elective care could safely continue, albeit at deescalated rates. COVID or septic patients underwent decompression with stent or nephrostomy insertion, while non-COVID and non-septic patients underwent primary ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). All interventions were done only by consultants, and surgical precautions such as donning of personal protective equipment were undertaken.4 We aim to report the outcomes of endourological surgery for stone disease in our centre during COVID. METHODS: We conducted a prospective review of all endourological surgeries for stones in our centre between 23 Jan and 31 Aug 2020, when all non-necessary surgeries were deferred. RESULTS: 201 surgeries were performed on 159 patients (93 emergencies, 108 electives)- 36 (17.9%) stent insertions, 116 (57.7%) URS and 49 (24.4%) RIRS. 34 patients were females and 125 males. Median age of patients was 50, with 37% ≥ 60. 31 patients were ASA ≥ 3. None were COVID positive. Mean single stone size was 8.17 mm (1-38) and cumulative stone size was 10.63 mm(1-84). 44 patients had multiple stones. The index stone location was proximal ureter in 111 (55.2%), mid ureter 19 (9.45%), distal ureter 67 (33.3%), renal 4 (1.99%). 55 (27.4%) procedures were carried out due to previously stented stones, 10 (4.98%) bilateral obstruction/ single kidney, 77 (38.3%) failed MET/ persistently symptomatic stone, 16 (7.96%) intractable colic, 14 (6.96%) AKI, and 20 (9.95%) sepsis. 166 (66.6%) patients had stent inserted post operatively- 15 with threads that precluded the need for scope guided removal. 27 (10.8%) had a ureteric catheter that was removed prior to discharge. The overall stone free rate was 97.4%;95 (59.7%) were stone free with 1 procedure. 60 (37.7%) required staged procedures. An average of 1.41 procedures/ patient was needed to be stone free. 2 (0.99%) patients had Clavien Dindo Grade III complications. 9 (4.48%) were readmitted- 7 for UTI and 1 for stent symptoms. Median length of stay was 2 days (0- 43). CONCLUSIONS: Our centre demonstrated favourable outcomes in patients undergoing endourological surgery for stone diseases during COVID by following strict screening protocols and surgical precautions. The results support the continuation of endourological surgery with the proposed framework in regions with similar COVID trends.