Procedural Guidelines Research Articles

Evidence-based procedures to improve the reliability of circulating miRNA biomarker assays.

Circulating cell-free microRNAs (cfmiRNA) are an emerging class of biomarkers that have shown great promise in the clinical diagnosis, treatment, and monitoring of several pathological conditions, including cancer.However, validation and clinical implementation of cfmiRNA biomarkers has been hindered by the variability introduced during different or suboptimal specimen collection and handling practices. To address the need forstandardization and evidence-based guidance, the National Cancer Institute (NCI) developed a new Biospecimen Evidenced-Based Practices (BEBP) document, entitled "Cell-free miRNA (cfmiRNA): Blood Collection and Processing". The BEBP, the fourth in the document series, contains step-by-step procedural guidelines on blood collection, processing, storage, extraction, and quality assessment that are tailored specifically for cfmiRNA analysis of plasma and serum. The workflow outlined in the BEBP is based on the available literature and recommendations of an expert panel. The BEBP contains the level of detail required for development of evidence-based standard operating procedures (SOPs) as well as the flexibility needed to accomodate (i)discovery- and inquiry-based studies and (ii) the different constraints faced by research labs, industry, clinical and academic institutions to foster widespread implementation. Guidance from the expert panel also included recommendations on study design, validating changes in workflow, and suggested quality thresholds to delineate meaningful changes in cfmiRNA levels. The NCI cfmiRNA: Blood Collection and Processing BEBP is available here as supplementary information as well as through the NCI Biorepositories and Biospecimen Research Branch (BBRB) (https://biospecimens.cancer.gov/resources/bebp.asp).

Simplified Legal Procedure for End-of-life Decisions in India: A New Dawn in the Care of the Dying?

Mani RK, Simha S, Gursahani R. Simplified Legal Procedure for End-of-life Decisions in India: A New Dawn in the Care of the Dying? Indian J Crit Care Med 2023;27(5):374-376.

Directive Emergency Evacuation Procedures Using MATLAB

This paper presents the development of directive emergency evacuation procedures for occupants of academic buildings. The development has four steps: determining a location as a starting point for evacuation, identifying the number of occupants in the building, referring to regulations and guidelines of emergency evacuation procedures, and designing an algorithm to be programmed in MATLAB software for desktop application. One academic building of the chemical and energy engineering faculty in Universiti Teknologi Malaysia is chosen to demonstrate the evacuation simulation. The algorithm is developed to direct occupants from any room in the building to a nearby assembly point. Occupants must provide inputs to the evacuation simulation, particularly the room’s number and level. Based on the inputs, occupants will get a word-based direction to the assembly point within an estimated time. Fifty students demonstrated the use of an emergency evacuation simulation in MATLAB. They are provided feedback concerning their awareness of emergency evacuation and the interaction with the simulation. Half of them responded that the evacuation simulation in MATLAB and their satisfaction was good and excellent. However, the algorithm is for one potential hazard and its location at a time, making it incapable of having inputs for many hazards. It is recommended that the algorithm is programmed to be used on a smartphone, allowing much easier dynamic emergency calling.

The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study.

With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis). A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

The MANTRA study: a new umbrella concept prospectively applied to assess implantable medical devices for heart valve procedures

BackgroundClinical evidence is commonly obtained through individual trials that are time-, cost- and resource-consuming, and which often leave unanswered clinically relevant questions. Umbrella studies have been developed to address the need for more efficient and flexible trial structures, predominantly for cancer treatments. The umbrella concept foresees data collection within a unifying trial structure, to which one or more substudies may be added at any time to address product- or therapy-specific questions. To our knowledge, the umbrella concept has not yet been used in the medical device area, but it may offer similar advantages as in other settings, particularly in areas where multiple therapies are available within one large treatment area.MethodsThe MANTRA study (NCT05002543) is a prospective, global, post-marketing clinical follow-up study. The aim is to collect safety and device performance data covering the Corcym cardiac surgery portfolio for the treatment of aortic, mitral, and tricuspid valve diseases. The study uses a master protocol that outlines the main common parameters, and the specific questions are addressed in three substudies. The primary endpoints are device success at 30 days. Secondary endpoints include safety- and device performance-related data at 30 days, 1 year, and then annually through to 10 years. All endpoints are defined according to the more recent guidelines for heart valve procedures. Additionally, procedure and hospitalization information are collected, including Enhanced Recovery after Surgery in sites using such protocols, and patient outcome measures such as New York Heart Association classification and quality-of-life questionnaires.ResultsThe study started in June 2021. Enrollment in all three substudies is ongoing.ConclusionsThe MANTRA study will provide contemporary information on the long-term outcomes of medical devices for the treatment of aortic, mitral, and tricuspid heart valve diseases in routine clinical practice. The umbrella approach adopted in the study has the potential of longitudinally assessing long-term efficacy of the devices and the flexibility to investigate new research questions as they arise.

PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyCME1 Apr 2023PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION Justina Tam, Heng Ruan, Matthew Mikula, Hannah Koenig, Alvaro Lucioni, Wai Lee, Jason Kim, Una Lee, and Kathleen Kobashi Justina TamJustina Tam More articles by this author , Heng RuanHeng Ruan More articles by this author , Matthew MikulaMatthew Mikula More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Wai LeeWai Lee More articles by this author , Jason KimJason Kim More articles by this author , Una LeeUna Lee More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor injection of onabotulinumtoxinA (BTX) is safe and efficacious in the treatment of neurogenic and non-neurogenic overactive bladder (OAB). Urinary tract infection (UTI) is a known potential adverse event. Published guidelines for cystoscopic procedures with manipulation recommend the use of prophylactic antibiotics, and prophylactic antibiotics are commonly administered pre-BTX. However, there is a paucity of data demonstrating that pre-procedural antibiotic administration decreases the rate of post-procedural UTI after BTX. In the era of antibiotic stewardship and avoidance of antibiotic overuse, we aimed to study the difference in UTI rates between patients asymptomatic for UTI who receive and do not receive antibiotics at the time of BTX in a prospective, randomized multi-institutional study. Here, we report our preliminary study results. METHODS: Patients with OAB undergoing BTX who were not symptomatic for UTI and had urinalysis demonstrating fewer than 2+ leukocyte esterase at the time of injection were randomized to receive either a single dose of pre-procedural prophylactic antibiotics or no antibiotics. Patients who had taken antibiotics within 48 hours of the procedure were excluded from study participation. Symptomatic UTIs within 2 weeks of injection was identified and recorded. Demographics and past medical history were recorded. RESULTS: Of 86 patients who have been enrolled, 40 were randomized to receive antibiotics, and 46 were randomized to not receive antibiotics. Table 1 summarizes the patient demographics, clinical history, and UTI rate. At 2-week follow up, a total of 4 patients developed UTI. One patient in the antibiotic group developed UTI, and 3 patients who did not receive antibiotics developed UTI. CONCLUSIONS: Our preliminary results suggest that the use of a single dose of prophylactic antibiotic may not affect the rate of post-procedural UTI. Patient enrollment is ongoing to determine if these findings hold true in a larger patient cohort. Source of Funding: 2020 Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction Foundation Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e413 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justina Tam More articles by this author Heng Ruan More articles by this author Matthew Mikula More articles by this author Hannah Koenig More articles by this author Alvaro Lucioni More articles by this author Wai Lee More articles by this author Jason Kim More articles by this author Una Lee More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement PDF downloadLoading ...

Owner Estimate of Rig Contracts in Oil and Gas Business According to Legal Certainty Principles

<p>As one of the vital and strategic natural resources and vital role that impact society, oil and gas is one of state revenue sources to support national development. To implement Article 33 of the 1945 Constitution, to obtain people welfare and prosperity, Oil and Gas Law No 22, 2001 mandated Special Task Force for Upstream Oil and Gas Business Activities to oversee upstream activity done by oil and gas contractors. Contractors conduct rig procurement processes with their Owner Estimate in alignment to Presidential decree No 12, 2021 and Summary of Procedural Guidelines of 007, 2017.By this reason, legal certainty is needed to deal with problems at implementation level. Two legal issues research, regulation and preparation implementation of Owner Estimate Value in Rig contract. The research analysis is using normative juridical which are supported by empirical studies. Owner Estimate preparation guidelines provide multiple interpretations, inconsistencies and a legal vacuum. In practice, problems related to aspects of legal certainty, Owner Estimate offers are not confidential and/or confidential, extreme price cut due to offers below 80% of Owner Estimate are being allowed, the existence of negotiations even though the price offer is already the lowest and below Owner Estimate . It opens for conspiracy in the procurement. It is necessary to amend Perpres and Procedural Guidelines of Special Task Force for Upstream Oil and Gas Migas Number 007 achieving compliance to the principles of agreement, legal certainty and fair business. Regulation change will provide legal certainty, efficiency and effectiveness so Special Task Force for Upstream Oil and Gas Migas, oil and gas contractors and Rig Providers can conduct upstream business activities properly, optimally to support Indonesian social welfare.</p><div> </div>

A systematic review of information technology in workplace learning

AbstractThe application of information technology is ubiquitous in our work and learning, and information technology causes tremendous changes to workplace learning. This systematic review aims to summarize the roles and impacts of information technology on workplace learning. This study is guided by the following three research questions: What are the characteristics and trends of the existing research on information technology in workplace learning(RQ1)? What roles does information technology play in workplace learning(RQ2)? What changes and impacts have information technology brought to workplace learning(RQ3)? We identified 60 eligible articles using the guidelines of the PRISMA procedures. To respond to RQ1, the descriptive analysis of the eligible literature has been delineated. To respond to RQ2, we conducted an in‐depth content analysis, and the roles of information technology were classified into four categories: at the organizational level, exploitative learning and explorative learning and at the individual level, learning resources and learning support. To respond to RQ3, the impacts of information technology were analyzed from both the positive and negative effects at the individual and organizational levels. Finally, we proposed an integrated framework of information technology on workplace learning.

Realizing Electronic Synapses by Defect Engineering in Polycrystalline Two-Dimensional MoS2 for Neuromorphic Computing.

Neuromorphic computing based on two-dimensional transition-metal dichalcogenides (2D TMDs) has attracted significant attention recently due to their extraordinary properties generated by the atomic-thick layered structure. This study presents sulfur-defect-assisted MoS2 artificial synaptic devices fabricated by a simple sputtering process, followed by a precise sulfur (S) vacancy-engineering process. While the as-sputtered MoS2 film does not show synaptic behavior, the S vacancy-controlled MoS2 film exhibits excellent synapse with remarkable nonvolatile memory characteristics such as a high switching ratio (∼103), a large memory window, and long retention time (∼104 s) in addition to synaptic functions such as paired-pulse facilitation (PPF) and long-term potentiation (LTP)/depression (LTD). The synaptic device working mechanism of Schottky barrier height modulation by redistributing S vacancies was systemically analyzed by electrical, physical, and microscopy characterizations. The presented MoS2 synaptic device, based on the precise defect engineering of sputtered MoS2, is a facile, low-cost, complementary metal-oxide semiconductor (CMOS)-compatible, and scalable method and provides a procedural guideline for the design of practical 2D TMD-based neuromorphic computing.

A Survey on forensic odontologists’ activity in Italy during the COVID-19 pandemic

Few information on virus contagion at the beginning of the covid-19 pandemic led to severe restrictions in the dental and forensic activity in Italy, the introduction of procedural guidelines and implementation of preventive measures. A specific survey on Italian forensic odontologists (FOds) activity was conducted to investigate the COVD-19 pandemic impact on daily practices, the preventive measures adopted to manage the risks of contagion procedures performed on living and dead people and the possible peculiar cases that required the intervention of a medical examiner. A total of 122 FOds answered, mostly males over 46 years coming from northern Italy. The results highlight the lack of specific guidelines for the procedures on living people compared to those on the dead but the regulations for the daily clinical practice resulted more than sufficient: in fact, more than 80% of FOds adopted the preventive and safety measures provided for dental practices. The forensic activity significantly decreased during the initial period (more than 75%) and gradually normalized to pre-pandemic numbers in approximately 50% of cases after the implementation of the vaccination campaign. 13 cases of occupational contagion have been reported, most of them (more than 85%) in northern and central Italy. In two cases members of the dental staff sued the employer for responsibility in the contagion. The decrease of the overall ID activity during the pandemic time can be more likely attributed to the of the dental data than the real impact of the pandemic regulations. The use of telematic tools, such as teleconferences, for many procedures proved to be an important resource useful for application even in post-pandemic times.

Circle of fortune: The long-term impact of Western customs institution in China

This paper examines the long-run effect of the customs institution founded by the Chinese Maritime Customs (CMC), a foreign-run customs agency established in the mid-19th century in China. A historical natural experiment is exploited to identify a causal effect: in 1902, the CMC took over a number of Chinese Native Customs stations, for which it established clear procedural guidelines and improved transparency and efficiency, while the other Native Customs stations remained under Chinese authority. Using the historical criterion that determined which Native Customs stations were taken over – those located within a 25 km radius of a CMC customs station – as a source of exogenous variation in the quality of the local customs institution, I show that counties historically affected by the CMC institution are more developed today relative to nearby but unaffected areas. Moreover, today’s business and bureaucracy in the affected counties suffer less from corruption, suggesting that the long-run effect of institutions can be explained by the cultural norms it fostered in the local society.

Methods for assessing guideline adherence for invasive procedures in the care of chronic coronary artery disease: a scoping review

ObjectivesIn the care of coronary artery disease (CAD), evidence questions the adequate application of guidelines for cardiovascular procedures, particularly coronary angiographies (CA) and myocardial revascularisation. This review aims to examine...

A Scoping Review for Cybersecurity in the Construction Industry

The 4th industrial revolution and its inherent digitalization are changing every aspect of the construction industry. However, these technological transformations bring new challenges, including cybersecurity. Although a number of studies in recent years have aimed to analyze cybersecurity issues in the construction sector, further research investment in this area is vital. The first step towards identifying needed and promising research directions in this domain is to systematically analyze the existing body of knowledge and detect knowledge gaps. This study addresses this need through a systematic scoping review designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR). To synthesize the existing knowledge, the extracted information is mapped with multiple benchmarks, including the National Institute of Standards and Technology (NIST) framework for cybersecurity management. The outcomes of the scoping review indicated that, from the construction perspective, the existing literature mainly focuses on a few areas, including Building Information Modeling (BIM), while other digital systems such as construction robots and prefabrication platforms need to be considered in future works. In terms of cybersecurity management, most of the existing studies focus on identifying risks and protecting assets. Other aspects of cybersecurity management, including detecting intrusions, responding to threats, and recovering from cyber-attacks need to be addressed in future studies. Regarding the technology-mediated countermeasures, the existing studies have explored only a limited number of potential solutions with a considerable focus on Blockchain-based systems, while the application of other countermeasures such as network virtualization can be a basis for future studies. Finally, the existing studies focused on procedural guidelines lack systematic solutions for areas including integrated cyber risk management and organizational change.

Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019-2020.

There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives. We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence. Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001). Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.

Guerra tra giganti. Il riconoscimento del patrimonio archeologico sardo tra conservazione e accessibilità

The recent initiatives aimed at promoting the recognition of the Sardinian archaeological heritage has generating two proposals included in the Tentative List: the "Domus de Janas", with surprising decorative elements, and the Nuragic civilization whose typological emblem, the nuraghe, is represented by the examples more significant. Both proposals concern the entire territory of Sardinia: here it is precisely archaeological architecture that constitutes the most recognizable asset with the most powerful meaning. Using the observation point of the Superintendency which participates in the process as territorial articulation of Ministry of Culture, it will be examine:• the legal status of the assets and the protection regime in place;• the conservation and maintenance projects made so far and for the future;• the state of accessibility to Heritage.The aims is to arrive at the drafting of a kind of state of the art and the guidelines for the recognition procedure.

A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools.

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.

Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT

PSMA-PET/CT for imaging prostate cancer (PC) has spread worldwide since its clinical introduction in 2011. The majority of experiences have been collected for PSMA-PET-imaging of recurrent PC. Data for primary staging of high-risk PC are highly promising. Meanwhile, a plethora of PSMA-ligands are available for clinical use (e. g. 68Ga-PSMA-11, 68Ga-PSMA-I&T, 68Ga-PSMA-617, 18F-DCFBC, 18F-DCFPyL, 18F-PSMA-1007, 18F-rhPSMA-7 and 18F-JK-PSMA-7). However, an official approval is available only for 68Ga-PSMA-11 (approved by the US FDA in 2020) and 18F-DCFPyL (approved by the US FDA in 2021).Recommendations for acquisition times vary from 1-2 h p. i. It has been shown that for the majority of tumour lesions, the contrast in PSMA-PET/CT increases with time. Therefore, additional late imaging can help to clarify unclear findings. PSMA-PET/CT should be performed prior to commencing an androgen deprivation therapy (ADT) since (long term) ADT reduces the visibility of PC lesions. Following injection of PSMA-ligands, hydration and forced diuresis are recommended for PSMA-ligands with primarily excretion via the kidneys in order to increase the visibility of tumour lesions adjacent to the urinary bladder.PSMA-ligands are physiologically taken up in multiple normal organs. For some 18F-labelled PSMA-ligands, presence of unspecific focal bone uptake has been reported. When using these tracers, focal bone uptake without CT-correlate should be interpreted with great caution. Besides prostate cancer, practically all solid tumors express PSMA in their neovasculature thereby taking up PSMA-ligands, although usually at a lower extent compared to PC. Also multiple benign lesions and inflammatory processes (e. g. lymph nodes) take up PSMA-ligands, also usually at lower extent compared to PC.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety

Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking. To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia. This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded. Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room. The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia). Of the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P < .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P < .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P < .001). Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.