Specific Checklist Research Articles

Combined or Sequential Treatment with Immune Checkpoint Inhibitors and Car-T Cell Therapies for the Management of Haematological Malignancies: A Systematic Review.

The aim of this paper was to review the available evidence on the efficacy and safety of combined or sequential use of PD-1/PD-L1 immune checkpoint inhibitors (ICI) and CAR-T cell therapies in relapsed/refractory (R/R) haematological malignancies. A systematic literature review was performed until 21 November 2022. Inclusion criteria: cohort studies/clinical trials aimed at evaluating the efficacy and/or safety of the combination of CAR-T cell therapy with PD-1/PD-L1 inhibitors in R/R haematological malignancies, which had reported results. Those focusing only on ICI or CAR-T separately or evaluating the combination in other non-hematological solid tumours were excluded. We used a specific checklist for quality assessment of the studies, and then we extracted data on efficacy or efficiency and safety. A total of 1867 articles were identified, and 9 articles were finally included (early phase studies, with small samples of patients and acceptable quality). The main pathologies were B-cell acute lymphoblastic leukaemia (B-ALL) and B-cell non-Hodgkin's lymphoma (B-NHL). The most studied combination was tisagenlecleucel with pembrolizumab. In terms of efficacy, there is great variability: the combination could be a promising option in B-ALL, with modest data, and in B-NHL, although hopeful responses were received, the combination does not appear better than CAR-T cell monotherapy. The safety profile could be considered comparable to that described for CAR-T cell monotherapy.

A-343 Provider Performed Microscopy Program Makeover: One Institution's Experience

Abstract Background Provider Performed Microscopy (PPM) is a subset of moderate complexity tests performed by physicians and midlevel practitioners. Regulatory bodies require PPM to meet specific accreditation standards. Many institutions face challenges with engaging providers to complete required training and ongoing assessments. Not immune to these challenges, we set out to improve PPM compliance. We reviewed guidelines to identify potential gaps in our PPM program. The existing PPM program practitioners were not aware of specific regulations and current learning systems were not robust enough to meet the regulations. The Point of Care Testing team (POCT) set out to establish a root cause for non-compliance, identify and collaborate with practitioners, and develop a sustainable training and competency system. Quality improvement must establish sustainable solutions to ensure compliance. Method POCT focused efforts on improving practitioner training, competency, and collaboration with practitioners. Over a period of 2 months, we identified and engaged key stakeholders in each department to review historical data from training, competency completion, and result audits revealing gaps. We clearly communicated the standards and how the current program was not meeting standards such as a lack of formalized training and competency documentation, observation of result documentation, and proper reporting of results. By identifying gaps in training, we utilized stakeholders to develop simple processes to enable compliance such as creation of a tip sheet to guide the resulting process, development of a specific training checklist requiring both provider and POC technical consultant (TC) signatures. In collaboration, a system was created to identify practitioner availability for direct observation of the specific elements of assessment. We leveraged our clinical consultant (CC) to assist in the conversations on a peer level with providers to bolster the importance of compliance. Every practitioner was re-trained by our TC along with the CC. With sustainability in mind, POCT collaborated with administrative assistants and department administrators to be notified of new practitioners. Ongoing monitoring involves POCT completing periodic check-ins with the departments as a second layer of assurance. POCT maintains the records of training and competency expiry dates and assigns critical thinking assessments. Results After 2 months, significant improvements were observed. Completed trainings improved from 50% to 100%, competency from 40% to 85%, and proper result documentation by practitioners from 25% to 70%. A 6-month review showed training was maintained at 100%, competency maintained at 85%, and result documentation improved to 90%. Sustainable improvements were observed at 1 year where training and result documentation achieved 100% compliance and competency completion reached 95%. Conclusion Sustainable quality improvement with PPM compliance was achieved by collaborating with practitioners, understanding obstacles to meeting standards, and developing simple solutions specific to practitioner workflows. In doing so, we were able to develop a robust yet succinct system for initiating and maintaining compliance with PPM regulatory standards.

Implementation of an Electrosurgical Checklist in a Podiatry Unit in Relation to a Case of Inadvertent Burns during Hallux Valgus Surgery

Iatrogenic burns are unpleasant and sometimes difficult to explain to patients. Podiatric surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. Although advances in technology have made electrosurgery increasingly safer for patients and personnel, its use is still poorly understood by the surgical community, and the hazards associated with its use still exist presently. Human error, direct or indirect transfer of electricity to a conductive device, or device malfunction can cause serious adverse events, including burns, electrical shocks, and or fires. Here, we report a rare case of a 43-year-old man who suffered severe burns during hallux valgus surgery. The surgeon and the nursing staff did not notice any injuries during the surgical intervention. This unusual clinical case serves to highlight the importance of implementing protocols to prevent injuries related to the use of electrosurgery. Based on this report, a specific checklist was implemented to prevent adverse events related to electrosurgery in our podiatric surgery unit to reduce the risk of electrosurgical complications. The implementation of the checklist can be useful to help health professionals improve patient safety during surgery and avoid potential medico–legal liability claims.

Importance of microbiology in autopsy procedure

The importance of bacterial cultures in autopsy has been controversial since Filippo Pacini and Robert Koch's early investigation into the etiology of cholera. Death-war and / or post-mortem invasion by the patient's native flora poses a problem with respect to post-mortem intervals, selection of anatomical location of cultures containing blood, CSF, and number of specimens required to be bought and collected in Microbial Laboratory for processing. Additionally, importance of postmortem virus research is significant. An increasingly important aspect of occupational safety is involved in handling of patient samples by laboratory staff. During the AIDS epidemic, regulatory bodies were urged to reconsider the importance of postmortem microbiological tests. This editorial is used to determine the exact cause of death without sacrificing the logistical and human resources of the Institute of Microbiology Practical sampling guidelines. The American University of Pathologists (CAP) are known to have developed a general checklist item for performing autopsy, but there are no specific guidelines, recommendations, or checklist items to address performance criteria for postmortem microbial culture studies. This review provides a brief historical perspective on autopsy microbiology, including a discussion of concerns about the postmortem spread of microorganisms, followed by a description of how to sample.

AVOIDable medical errors in invasive procedures: Facts on the ground - An NHS staff survey.

Never Events represent a serious problem with a high burden on healthcare providers' facilities. Despite introducing various safety checklists and precautions, many Never Events are reported yearly. This survey aims to assess awareness and compliance with the safety standards and obtain recommendations from the National Health Service (NHS) staff on preventative measures. An online survey of 45 questions has been conducted directed at NHS staff involved in invasive procedures. The questions were designed to assess the level of awareness, training and education delivered to the staff on patient safety. Moreover, we designed a set of focused questions to assess compliance with the National Safety Standards for Invasive Procedures (NatSSIPs) guidance. Open questions were added to encourage the staff to give practical recommendations on tackling and preventing these incidents. Invitations were sent through social media, and the survey was kept live from 20/11/2021 to 23/04/2022. Out of 700 invitations sent, 75 completed the survey (10.7%). 96% and 94.67% were familiar with the terms Never Events and near-miss, respectively. However, 52% and 36.49% were aware of National and Local Safety Standards for Invasive procedures (NatSSIPs-LocSSIPs), respectively. 28 (37.33%) had training on preventing medical errors. 48 (64%) believe that training on safety checklists should be delivered during undergraduate education. Fourteen (18.67%) had experiences when the checklists failed to prevent medical errors. 53 (70.67%) have seen the operating list or the consent forms containing abbreviations. Thirty-three (44%) have a failed counting reconciliation algorithm. NHS staff emphasised the importance of multi-level checks, utilisation of specific checklists, patient involvement in the safety checks, adequate staffing, avoidance of staff change in the middle of a procedure and change of list order, and investment in training and education on patient safety. This survey showed a low awareness of some of the principal patient safety aspects and poor compliance with NatSSIPs recommendations. Checklists fail on some occasions to prevent medical errors. Process redesign creating a safe environment, and enhancing a safety culture could be the key. The study presented the recommendations of the staff on preventative measures.

Development and preliminary validation of an Objective Structured Assessment of Technical Skills (OSATS) for a partial pulpotomy procedure.

To develop an Objective Structured Assessment of Technical Skills (OSATS) tool for partial pulpotomy and to preliminary assess the validity of this tool. Secondary objectives were to check internal consistency as well as the interrater reliability of this specific checklist and to compare it with the previously validated global rating score (GRS). The study assessed three groups of dental participants (mix of practitioners or students) possessing differing levels of clinical experience (7 novices, 7 intermediates, 7 experts), during a partial pulpotomy procedure on a simulated tooth with deep caries, using a bespoke procedure-specific checklist (PSC) and the GRS. Two independent examiners received the study participants in groups of two, in order to be able to directly observe their actions and grade the different steps of the procedure from 1 to 5 on the PSC and GRS. The internal validity of the specific checklist was assessed using a Cronbach's alpha test. As the construct validity of such a tool can be determined when the tool differentiates performance based on the level of experience, the total score of the PSC of the three groups (e.g., novice group, intermediate group, experienced group) were compared using the Kruskal-Wallis and post-hoc Mann-Whitney pairwise U test. The total scores of the GRS were also analysed in the same manner. A correlation test (Correlation Matrices Test) was carried out for the entire sample between the specific checklist and the GRS (on total score). The intraclass correlation coefficient was used to measure the degree of agreement between the two evaluators. The statistical analysis was performed with XLSTAT® and Statistica® (significance p = .05). The partial pulpotomy specific checklist graded from one to five demonstrated good internal consistency (0.86) and a good interrater reliability (0.91), a correct construct validity (p generally < .05) and a good positive correlation with the validated GRS (r = .92). To address the need to develop education in vital pulp treatment, and more specifically the technical skills assessment of partial pulpotomy, an OSATS-specific checklist was developed and preliminary validated. The checklist will need to be validated in larger cohorts.

An electronic operation note proforma improves the quality of operation notes in burns surgery.

An Operation Note should provide a comprehensive account of the details of a surgical procedure performed and document clinically relevant events which occur throughout the procedure. The Royal College of Surgeons of England, in 2014, updated guidelines on specific criteria to be included in operation notes. Standardisation using procedure-specific operation notes has been shown to significantly improve adherence to these guidelines. The aim of this study was to evaluate the quality of operation notes in the Irish National Burns Unit before and after the design and implementation of an electronic patient record and the subsequent introduction of an operation template and a burns surgery specific checklist, within the electronic system. A 30-point checklist was designed based on existing sources. Operation notes prior to and following the adoption of a electronic-based operation note were analysed, and then reanalysed following the introduction of a procedure-specific operation note. Ninety-three operation notes were included for analysis. An electronic operation record significantly improved the quality of documentation within our unit. The subsequent procedure specific operation note had a significant improvement across all areas and achieved 100% compliance in many categories. The use of an electronic patient record to document a patient's procedure has been shown to significantly improve the quality of documentation. One could expect this to result in an improved patient hand-over and subsequent episode of care. We highlight a number of initial pit-falls that others may avoid in their implementation of a digital record.

Rollout of Closed-Loop Technology to Pregnant Women with Type 1 Diabetes: Healthcare Professionals' Views About Potential Challenges and Solutions.

Aims: To explore healthcare professionals' views about the training and support needed to rollout closed-loop technology to pregnant women with type 1 diabetes. Methods: We interviewed (n = 19) healthcare professionals who supported pregnant women using CamAPS FX closed-loop during the Automated insulin Delivery Amongst Pregnant women with Type 1 diabetes (AiDAPT) trial. Data were analyzed descriptively. An online workshop involving (n = 15) trial team members was used to inform recommendations. Ethics approvals were obtained in conjunction with those for the wider trial. Results: Interviewees expressed enthusiasm for a national rollout of closed-loop, but anticipated various challenges, some specific to use during pregnancy. These included variations in insulin pump and continuous glucose monitoring expertise and difficulties embedding and retaining key skills, due to the relatively small numbers of pregnant women using closed-loop. Inexperienced staff also highlighted difficulties interpreting data downloads. To support rollout, interviewees recommended providing expert initial advice training, delivered by device manufacturers together with online training resources and specific checklists for different systems. They also highlighted a need for 24 h technical support, especially when supporting technology naive women after first transitioning onto closed-loop in early pregnancy. They further recommended providing case-based meetings and mentorship for inexperienced colleagues, including support interpreting data downloads. Interviewees were optimistic that if healthcare professionals received training and support, their long-term workloads could be reduced because closed-loop lessened women's need for glycemic management input, especially in later pregnancy. Conclusions: Interviewees identified challenges and opportunities to rolling-out closed-loop and provided practical suggestions to upskill inexperienced staff supporting pregnant women using closed-loop. A key priority will be to determine how best to develop mentorship services to support inexperienced staff delivering closed-loop. Clinical Trials Registration: NCT04938557.

Semi-quantitative risk assessment of African swine fever virus introduction in pig farms.

A semi-quantitative risk assessment was developed to classify pig farms in terms of the probability of introduction of African swine fever virus (ASFV). Following on-farm data collection via a specific checklist, we applied a modified failure mode and effect analysis (FMEA) to calculate the risk priority codes (RPC's), indicating increasing risk levels ranging from 1 to 5. The importance of biosecurity measures was attributed by experts. To consider geographic risk factors, we classified pig farms based on local density of farmed pigs, and on the estimated wild boar population density. The combination of RPC's with geographical risk factors resulted into a final ranking of pig farms in terms of the risk of ASFV introduction. Furthermore, the estimation of frequency and levels of non-compliance with biosecurity measures was used to identify weak points in risk prevention at farm level. The outcome of the risk assessment was affected by choices in assigning non-compliance scores and importance to specific components of biosecurity. The method was applied in 60 commercial farms in major pig production areas in Italy. Furthermore, we applied a reduced version of our checklist in 12 non-commercial/small commercial (≤20 pigs) farms in the northern Apennines. In commercial farms, highest RPC's were obtained for biosecurity measures associated with personnel practices and farm buildings/planimetry. Intervention should be addressed to training of personnel on biosecurity and ASF, to avoid contacts with other pig herds, and to improve practices in the entrance into the farm. Sharing trucks with other farms, and loading/unloading of pigs were other weak points. Fencing was classified as insufficient in 70% of the commercial farms. Among these farms, breeding units were characterised by the lowest risk of ASFV introduction (although differences among median ranks were not statistically significant: P-value = 0.07; Kruskal-Wallis test), and increasing herd size was not significantly correlated with a higher risk (Kendall's τ = -0.13; P-value = 0.14). Density of farmed pig was greatest in the main pig production area in northern Italy. Conversely, exposure to wild boars was greatest for non-commercial/small commercial farms on the Apennines, which were also characterised by non-compliance with critical biosecurity measures.

Effectiveness of different requirements checklists for novice designers

Working under constrained conditions can boost or kill creativity, depending on the nature of the constraints (organizational, personal or task-related). However, a design process without clearly identified constraints, which set the project objectives, could lead to inefficiencies and unfruitful iterations. Some of the most acknowledged procedures to support requirement definition are focused on the use of specific checklists. However, notwithstanding the importance of the task, little attention was dedicated to the verification of the effectiveness of these tools. In such a context, the paper presents an investigation aimed at assessing the performance of three checklists that exploit different strategies to elicit requirements. To that purpose, a sample of fifty engineering students was asked to use the checklists to define the requirements for a specific design case. The outcomes of the experiment were assessed according to well-acknowledged effectiveness metrics, i.e. quantity, operationality, validity, non-redundancy, and completeness. The result of the assessment highlights that checklists based on more general questions or abstract stimuli can better support novice designers in making explicit internally felt design constraints that can potentially lead to more innovative design.

ENVIRONMENTAL HEALTH AND SAFETY ISSUES ASSOCIATED WITH INDUSTRIAL ACTIVITY IN INDUSTRIAL ESTATE LAHORE

The relationship between achieving an ecological future, economic growth, andhuman well-being has a long and varied philosophical history. Environmental health and safety(EHS) refers to the recognition, accurate assessment, and prevention of various health risks at workas well as the preservation of employees' productivity. On the other hand, ergonomics combines allof these issues to enhance the competency and well-being of workers. For this particular studyproject, an industrial estate was chosen, and it was further separated into three subzones formonitoring and assessment purposes. Instead of focusing on specific concerns, Industrial Estatewas created to address the difficulties associated with industrialization as a whole. The utilizationof two major data gathering techniques was employed. A specific checklist for EHS proceduresand a review of the site area from an EHS perspective. To address the general situation of theindustrial region, the appropriate measures of the various operations were also taken intoconsideration. Reviewing complaints and accident reports, conducting interviews, and othertechniques are examples of further data collecting approaches. The majority of the results were inconformity with national norms of PEQs and international standards of the World HealthOrganization (WHO), according to a comparison of monitoring reports for ambient air quality andwater quality. The PEQS-defined limit for PM10 was being exceeded. The graphs show how theair and water quality are currently in each location of the industrial site. The industrial estate's keyproblem zones have also been highlighted by the risk assessment matrix. However, a number ofconsiderations suggested that improving the way EHS procedures were implemented wasnecessary for EHS compliance with corporate SOPs.

Analysis of moral courage and related factors among undergraduate nursing students: a scoping review.

to analyze scientific evidence on moral courage and related factors among nursing undergraduate students. the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist. a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field. few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study

ObjectivesPatients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. Design & settingSingle-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. ResultsOne hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9–16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6–9, range: 2 – 17). Median duration of ECMO support was 14 days (IQR: 9–24), whereas the ICU stay was 24 days (IQR:18–44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). ConclusionIn this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.

Self-assessment Checklists for Internal Audits on Design Requirements in Italian PET Imaging Centers and Cyclotron Facilities

Abstract: In this work the authors intend to provide a list of useful operational criteria to approach, with the best practice, the design of PET imaging centers and cyclotron facilities for the production of PET radioisotopes in Italy. Special attention is devoted to organizational and safety aspects. In order to prompt toward a systematic application of the proposed indications, the article presents them in form of a specific self-assessment checklist, consisting in a list of items which involve the design process in all the different phases. This checklist represents a useful toolkit during the design phase and subsequently for internal audits.

Assessing the Learning Process of Transforaminal Endoscopic Discectomy for Sciatica.

ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED. MethodsThis analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED. ResultsIn total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains “time and motion,” “respect for tissue,” and “knowledge and handling of instruments.” Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in “depth-perception” and “autonomy.” Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15. ConclusionBased on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.

Radiotherapy prioritization in 143 national cancer control plans: Correlation with radiotherapy machine availability, geography and income level

BackgroundIn 2015, the Global Task Force on Radiotherapy for Cancer Control (GTFRCC) called for 80% of National Cancer Control Plans (NCCP) to include radiotherapy by 2020. As part of the ongoing ESTRO Global Impact of Radiotherapy in Oncology (GIRO) project, we assessed whether inclusion of radiotherapy in NCCPs correlates with radiotherapy machine availability, national income, and geographic region. MethodsA previously validated checklist was used to determine whether radiotherapy was included in each country’s NCCP. We applied the CCORE optimal radiotherapy utilisation model to the GLOBOCAN 2020 data to estimate the demand for radiotherapy and compared this to the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres (DIRAC) supply data, stratifying by income level and world region. World regions were defined according to the IAEA. FindingsComplete data (including GLOBOCAN 2020, DIRAC and NCCP) was available for 143 countries. Over half (55%, n = 79) included a radiotherapy-specific checklist item within the plan. Countries which included radiotherapy services planning in their NCCP had a higher median number of machines (1.68 vs 0.75 machines/1000 patients needing radiotherapy, p < 0.001). There was significant regional and income-level heterogeneity in the inclusion of radiotherapy-related items in NCCPs. Low-income and Asia-Pacific countries were least likely to include radiation oncology services planning in their NCCP (p = 0.06 and p = 0.003, respectively). Few countries in the Asia-Pacific (18.6%) had a plan to develop or maintain radiation services, compared to 57% of countries in Europe. InterpretationOnly 55% of current NCCPs included any information regarding radiotherapy, below the GTFRCC’s target of 80%. Prioritisation of radiotherapy in NCCPs was correlated with radiotherapy machine availability. There was regional and income-level heterogeneity regarding the inclusion of specific radiotherapy checklist items in the NCCPs. Ongoing efforts are needed to promote the inclusion of radiotherapy in future iterations of NCCPs in order to improve global access to radiation treatment. FundingNo direct funding was used in this research.

742 Quality of Operative Notes for Renal Transplant Surgery - Is Our Documentation Satisfactory?

Abstract Introduction Operation notes are essential in providing details of the procedure undertaken. The Royal College of Surgeons (RCS) Good Surgical Practice (GSP) guidelines recommend a checklist of 18 documentation items. Although these guidelines are useful, their broad and non-specific nature provides limitations to fields like transplantation, where additional information is needed. Ghoneima et al recommended transplant specific GSP checklist of 32 criteria for operation notes in transplantation. Our aim is to evaluate renal transplantation operation notes against these criteria. Method A retrospective audit of renal transplant operation notes was undertaken within Cardiff Transplant Unit between October 2020–2021. Notes were reviewed against new transplant specific GSP checklist. Results A total of 85 renal transplants were performed by 8 Consultant Surgeons. Sixty-two (73%) operation notes were hand-written and 23 (27%) electronically typed. Eleven standards had documentation compliance of &amp;gt;95% (e.g., date, surgeons’ names, recipient blood vessels, incision, allograft vascular anatomy, perfusion timings, closure, signature, etc). Some important transplant-specific information (e.g., primary renal disease, details of current renal replacement therapy, reperfusion characteristics, donor details (e.g., age, comorbidities), HLA mismatch, prosthesis (ureteric stent) details) were poorly documented (0–27% documentation compliance). Antibiotic and DVT prophylaxis documentation was also very poor (1–30%). Post-operative instructions did not record target blood pressure (0%) and postoperative potassium and ultrasound scan instructions were recorded in 65% of notes. Discussion Clear documentation is important for good surgical practice. This study highlights the need for a transplant-specific operation notes template, to not only improve the documentation but to standardize the key information recorded for every transplant performed.

Rancang Bangun Website Project Management Untuk Project Specific Repository Checklist Pt Anabatic Digital Raya Menggunakan Metode Rad (Rapid Application Development)

The development of the digital era is currently progressing very rapidly. Website-based applications can be a solution needed by companies that want to develop a more integrated online communication and information system. PT Anabatic Digital Raya is improving the efficiency and effectiveness of the Compliance Officer (CO) team in the process of checking project documents. By building a project management website application for the Project Specific Repository Checklist file by applying the RAD (Rapid Application Development) method, the goal to be realized will be achieved, namely increasing the efficiency and effectiveness of the Compliance Officer team.

Comparison of multimodal active learning and single-modality procedural simulation for central venous catheter insertion for incoming residents in anesthesiology: a prospective and randomized study

BackgroundActive learning methods, including low-fidelity simulation, are useful but the incremental learning effect of each method is however limited. We designed this study to assess if combining flipped classroom and the modified Peyton’s « 4-steps» method during procedural simulation (intervention group [IG]) would provide better learning results than simulation alone (control group [CG]) in the context of central venous catheter insertion training.MethodsThis prospective, single-center, and randomized study took place in 2017 in a single simulation center. All first year Anesthesiology residents of Ile de France area at the start of their residency were randomly included either in the IG or CG during a seminar aimed at providing initial procedural skills with low-fidelity simulation. A composite learning score which included knowledge MCQ and a questionnaire assessing satisfaction and value of the training session was recorded after training (primary outcome, /100). A randomized sub-group of learners of each group were video-recorded during central venous catheter insertion at the end of training and their skills were evaluated with validated tools, including a specific checklist and a global rating scale (GRS).ResultsAmong 89 anesthesiology residents, 48 and 41 learners were randomized in the intervention and control groups respectively. Of the IG residents, 40/48 (83%) had read the learning material prior to the session. There was no significant difference regarding the composite outcome ([IG]= 81.1 vs [CG] = 80.5 /100 (p = 0.68)). Results of the post-session MCQ knowledge questionnaire were also non-significantly different. Residents were similarly satisfied and described a significant improvement of their knowledge and skills after training. Learners highly valued the training session as a mean to improve their future practice. No significant differences regarding checklist and GRS scores were observed.ConclusionsA multimodal active learning strategy of procedural learning did not provide better learning outcomes when compared to a traditional simulation method. In both groups, satisfaction was high and perception of the acquired theoretical and practical knowledge was improved after training.

Engaging Early-Career Physicians in Medical Device Innovation and Entrepreneurship.

Engaging Early-Career Physicians in Medical Device Innovation and Entrepreneurship.