Standardized Process Research Articles

Treatment of primary epididymal adenocarcinoma: a case report and review of the literature

BackgroundEpididymal tumors, especially malignant tumors, have low incidence and are rare in our clinical work. However, they may progress quickly and have poor prognosis. For such rare clinical cases with extremely low incidence rates, and as they are prone to misdiagnosis and missed diagnosis and have a very poor prognosis, clinical workers need to pay special attention and consider the possibility of primary epididymal malignant tumors.Case reportA 63-year-old Chinese male patient from Asia was admitted due to scrotal pain. Upon examination, an abnormal lesion was found in the right epididymal region. After thorough evaluation, surgical resection was performed, and the postoperative pathological result confirmed the presence of epididymal adenocarcinoma. After further ruling out secondary lesions, primary epididymal adenocarcinoma was considered. Right retroperitoneal lymph node dissection was performed under laparoscopic for treatment, and 1/11 lymph node metastasis was detected after surgery. The patient is currently under close follow-up.ConclusionsThe number of clinical cases of primary epididymal malignant tumors is very limited, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods regarding the effectiveness of different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. In addition, the outcome is difficult to predict. In this article, we reviewed relevant literature and systematically elaborated on the diagnosis and treatment of epididymal malignant tumors, hoping to provide useful information for relevant experts.

Review of Lab-Accelerated Aging Techniques of Asphalt Mixes

Bitumen aging contributes to main pavement distress due to the changes in rheological, chemical, and physical characteristics of bitumen. Mainly, aging process can be divided into two categories, the first category namely short-term aging takes place during the heating up of bitumen and aggregate, mixing, transportation, laying down, and compaction. While the second category of aging takes place during the service life of pavement which is denoted as long-term aging. Consequently, researchers’ focus is to simulate bitumen aging in the lab by developing lab-accelerated methods to simulate the process of bitumen aging and studying the rate of change before and after aging. This article reviews these methods and compares the extent of the impact on lab-aged bitumen with old bitumen. The main outcome is, that the duration of exposure to high temperatures, which is the dominant method to accelerate aging process, resulted in inadequate changes in the structure of the bitumen molecule, hence, making it different from old bitumen. For that reason, using oxidants such as hydrogen peroxide showed more reliable results but requires more attention by researchers to achieve a standardized aging process of bitumen.

Impact of Continuous Renal Replacement Therapy Initiation Time, Kidney Injury, and Hypervolemia in Critically Ill Children.

The mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes. In the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown. This quality improvement process involved a retrospective review of data on patients who received continuous dialysis in the pediatric intensive care unit from January 1, 2017, to December 31, 2021. The objectives were to examine the characteristics of the children requiring continuous renal replacement therapy, therapy initiation times, and factors associated with initiation delays that might affect unit length of stay and mortality. During the study period, 175 patients received continuous renal replacement therapy, with an average initiation time of 11.9 hours. Statistically significant associations were found between the degree of fluid overload and mortality (P < .001) and between the presence of acute kidney injury and prolonged length of stay (P = .04). No significant association was found between therapy initiation time and unit length of stay or mortality, although the average initiation time of survivors was 5.9 hours shorter than that of nonsurvivors. Future studies are needed to assess real time delays and to evaluate if the implementation of a standardized initiation process decreases initiation time.

Developing, Implementing, Evaluating Electronic Apparent Cause Analysis Across a Health Care System

An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, human factors engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).

Adaptation of COMPASS for use in Autism-Specific Schools in Australia: A Cluster Randomized Trial.

Autistic students are educated in Australia across a variety of contexts and almost all educators use individualized goal-setting as a way of ensuring appropriate accommodations and curriculum modifications. Educators experience similar challenges when developing individualized goals for students, including lack of a standardized process for goal setting, inconsistent support networks, and challenges with data-driven goal-setting. The purpose of our research was to adapt and trial the Collaborative Model for Competence and Success (COMPASS), a research-based intervention aimed at improving the individualized goal-setting process for autistic students. Our primary hypothesis was that autistic students who participate in COMPASS would demonstrate more growth on their individualized outcomes relative to autistic students who receive services as usual (SAU). To answer our primary research question, we applied a single-blind cluster randomized trial. Participants were randomized into one of two groups: (a) a COMPASS intervention group and (b) a SAU group. Results indicate that students whose teachers received the intervention made more progress on their final individualized goals than those who received SAU, replicating previous findings regarding COMPASS in the US. Also, the adaptation of COMPASS for an Australian context showed high rates of satisfaction and fidelity. The success of this intervention in improving the progress that students make on their individualized goals demonstrates the benefits of a standardized intervention that supports teachers and families in this critical practice.

The Use of Ultraviolet Irradiation to Improve the Efficacy of Acids That Are Generally Recognized as Safe for Disinfecting Fresh Produce in the Ready-to-Eat Stage.

Fresh-cut produce is usually produced under standardized disinfection processes, which are unavailable at the ready-to-eat stage. Currently, chemical sanitizers are used for washing, but their disinfection efficacy is limited. In this study, UV-C (1.03 kJ/m2) was combined with organic acids that are generally recognized as safe (GRAS), including citric, malic, acetic, and lactic acids (LAs), to wash lettuce and cherry tomatoes that are contaminated with Escherichia coli O157:H7 and Salmonella Typhimurium. The results showed that LA was the most effective treatment among the single treatments, with a pathogen reduction and cross-contamination incidence of 2.0-2.3 log CFU/g and 28-35%, respectively. After combining with UV-C, the disinfection efficacy and cross-contamination prevention capacity of the four GRAS acids significantly improved. Among the combination treatments, the highest pathogen reduction (2.5-2.7 log CFU/g) and the lowest cross-contamination incidence (11-15%) were achieved by LA-UV. The analyses of ascorbic acid, chlorophyll, lycopene, antioxidant capacity, and ΔE indicated that neither the single nor combination treatments negatively affected the quality properties. These results provide a potential hurdle technology for fresh produce safety improvement at the ready-to-eat stage.

A standardized protocol using clinical adjudication to define true infection status in patients presenting to the emergency department with suspected infections and/or sepsis

In absence of a “gold standard”, a standardized clinical adjudication process was developed for a registrational trial of a transcriptomic host response (HR) test. Two physicians independently reviewed clinical data to adjudicate presence and source of bacterial and viral infections in emergency department patients. Discordant cases were resolved by a third physician. Agreement among 955 cases was 74.1% (708/955) for bacterial, 75.6% (722/955) for viral infections, and 71.2% (680/955) overall. Most discordances were minor (85.2%; 409/480) versus moderate (11.7%; 56/480) or complete (3.3%; 16/480). Concordance levels were lowest for bacterial skin and soft tissue infections (8.2%) and for viral respiratory tract infections (4.5%). This robust adjudication process can be used to evaluate HR tests and other diagnostics by regulatory agencies and for educating clinicians, laboratorians, and clinical researchers. Clinicaltrials.gov NCT04094818. SummaryWithout a gold standard for evaluating host response tests, clinical adjudication is a robust reference standard that is essential to determine the true infection status in diagnostic registrational clinical studies.

Sustainable management of small-town water supply in Nepal: improvement through the multi-stage training mechanism

ABSTRACT In Nepal, a project to sustain a safe water supply for small towns was executed in 68 towns, each with distinctive water sources and topographical situations. This project adopted two approaches to establish a standardized capacity development process for small-town water supplies. The first approach, the Management Model, consists of standard operating procedures (SOPs) and business planning. The second approach, termed the Support Model, entails a comprehensive system for training, monitoring, and evaluating water supply management. Throughout the project, a total of 31 SOPs pertaining to operation, maintenance, and facility rehabilitation manuals were developed. Moreover, four courses consisting of training, basic and on-site training, and interactive workshops were conducted. Consequently, the data deficiency rate reduced significantly by 61%, while 87% of water samples met water quality standards. In contrast, the operating ratio and water production rates improved by 17 and 29%, respectively. The materials produced from these models are expected to contribute to small-town water supply systems beyond the pilot sites. This is due to the versatility of the model for future applications. Although the project was effectively implemented, continuous support for small-town water supply by the Government of Nepal is needed for future sustainability.

Building Geriatric Trauma Programs in Resource-Constrained Environments: Trauma Quality Improvement Program Guideline Implementation at Two Safety Net Hospitals in Southern California.

Background: To improve care of geriatric trauma patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) updated guidelines in 2021. Amid geriatrician shortages in Southern California, 2 Los Angeles County safety net hospitals were tasked with creating a strategy to meet geriatric trauma guidelines despite constrained resources. Methods: All trauma patients ≥ 60years admitted to a safety net hospital in Southern California were enrolled without exclusions (August 2022-April 2023). Primary outcome was frailty screening with documentation to identify older trauma patients at a high risk for adverse outcomes. Results: Needs assessment discovered no standardized process to identify high-risk geriatric patients, no geriatric care guidelines, and no inpatient geriatric consultation service. An action plan composed of a resident-led frailty screen resulted in identification of high-risk patients. Overall, 217 patients met criteria. Ninety-six patients (44%) successfully underwent frailty screening. Frailty screening compliance increased over the study, beginning at 37% capture in the first month and increasing to 81% in the final study month. After achieving nearly uniform frailty screening, a form was developed for the EMR for ease of documentation, data capture/tracking, and compliance monitoring. Discussion: In this study, creativity, collaboration, and resourcefulness allowed TQIP guideline implementation at 2 county hospitals. A systematic process is now in place to identify and triage high-risk geriatric trauma patients based on frailty screen to receive inpatient medicine consultation for medical comorbidity optimization. Continued interdisciplinary and interfacility collaboration will be crucial for continued delivery of the optimal care to older injured patients.

Implementing a Barcode-Based Whole-Life Cycle Management Process to Improve Robotic Instrument Tracking.

Minimally invasive surgery can involve the use of robotics to improve patient outcomes. Some robotic systems require special instruments with a designated number of uses. In China, during the reprocessing of the robotic instruments, health care personnel determined that the existing tracking processes were inadequate. They conducted a quality improvement project with the goal of establishing a barcode-based standardized process for tracking robotic instruments. They implemented technology that generated a unique identifier each time a robotic instrument was reprocessed after use. Nurses scanned the identifier when surgeons used the instrument. The findings included the increased accuracy of use documentation and decreases in untraceable sterilization and use records, charging concerns, and average daily and monthly inventory times. An increase in adverse event reports associated with robotic instruments also was noted. The use of barcode technology for robotic instrument tracking continues at the facility and may be expanded for additional specialty instruments.

FAST and Furious About Quality: Impact of Continuous Review and Feedback on Point-of-Care Ultrasound Examinations.

Background: Focused Assessment with Sonography in Trauma (FAST) examination is a point-of-care ultrasound study used to evaluate for abdominal hemorrhage, pneumothorax, or pericardial blood in trauma patients as an adjunct to their initial assessment. The quality of the image can be limited, and its diagnostic value is heavily dependent on operator skill. Our objective was to determine whether a standardized review process improved image quality and reduced incidence of nondiagnostic or insufficient imaging by 10% over a 6-month period. Study Design: Between July 1, 2021, and March 31, 2022, we evaluated 1106 trauma activations at our level II trauma center. Two exams per practitioner per month were reviewed by an emergency medicine trained traumatologist with specialized training in point-of-care ultrasound and board certification in echocardiography. Priority was given to exams on patients with known injuries identified on other studies. If there were no exams that matched these criteria, random exams were selected. Images were reviewed for image quality, diagnostic accuracy, and labeling with counseling given to the provider if indicated. Categorical variables were compared using chi squared analysis, while continuous non-normally distributed variables were compared using the Mann-Whitney U test. Results: A total of 305 FAST exams were reviewed (186 pre-intervention and 119 during intervention). Image quality improved from 46.3% (n = 31/65) to 79.0% (n = 94/119) (P < .01) with need for counseling falling from 63.1% (n = 41/65) pre-QI to 42.0% (n = 50/119) post-QI (P < .01). Incidence of detectable injury, BMI, ISS, and AIS body regions were consistent across the study period. This was seen in both the geriatric and non-geriatric cohorts despite a significant increase in ISS in the post-intervention geriatric patients.Discussion: A FAST review program is associated with improvement in image quality and decreased need for counseling of trauma providers.

Pest Detection and Classification in Peanut Crops

Recent advancements in image processing have significantly improved pest detection and classification in peanut crops. Our study introduces an innovative approach that optimizes image features for accurate pest identification. Leveraging insights from successful image analysis methodologies, our model employs a tailored architecture for pest detection, segmentation, and classification tasks. By integrating dual branch segment representations and a dual-layer transformer encoder, we aim to enhance image representations and consolidate pest image segments of varying sizes. We evaluate our approach using three distinct pest datasets—Aphids, Wireworm, and Gram Caterpillar—ensuring comprehensive analysis and model validation. Prior to training, we preprocess the datasets extensively, employing feature extraction techniques and addressing image quality issues. We then apply normalization procedures to standardize the data for seamless integration into our model architecture. Our methodology focuses on extracting key features through self-attention mechanisms and standardized scaling processes to enhance predictive capabilities. Comprehensive experimentation demonstrates the superiority of our approach, outperforming established benchmarks in pest detection and classification with high accuracy rates. In summary, our study presents a novel framework that optimizes feature extraction and enhances predictive accuracy in pest detection and classification for peanut crops, addressing the unique challenges of agricultural pest identification.

Chinese expert consensus on clinical practice of daytime hip arthroplasty

Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.

Smarter smiles: The role of AI in modern periodontics

The profound impact of unmet oral health needs on systemic health remains a significant concern, particularly among vulnerable populations. Disparities such as low health literacy and limited access to care contribute to higher rates of oral diseases and poorer health outcomes. These disparities can exacerbate chronic systemic conditions like diabetes, cancer, and cardiovascular disease. Additionally, the absence of standardized practices among dental clinicians regarding the diagnosis, treatment, and management of periodontitis leads to inconsistencies in care utilization. Therefore, prioritizing approaches to care that enhance patient engagement, improve health literacy, and promote standardized care is imperative. Dentistry has historically emphasized delivering comprehensive care by embracing emerging technology and scientific evidence. The integration of AI holds promises in empowering patients through standardized care processes and enhanced access to health information.

Digital pathology structure and deployment in Veneto: a proof-of-concept study

Nowadays pathology laboratories are worldwide facing a digital revolution, with an increasing number of institutions adopting digital pathology (DP) and whole slide imaging solutions. Despite indeed providing novel and helpful advantages, embracing a whole DP workflow is still challenging, especially for wide healthcare networks. The Azienda Zero of the Veneto Italian region has begun a process of a fully digital transformation of an integrated network of 12 hospitals producing nearly 3 million slides per year. In the present article, we describe the planning stages and the operative phases needed to support such a disruptive transition, along with the initial preliminary results emerging from the project. The ultimate goal of the DP program in the Veneto Italian region is to improve patients’ clinical care through a safe and standardized process, encompassing a total digital management of pathology samples, easy file sharing with experienced colleagues, and automatic support by artificial intelligence tools.

Implementation of quality indicators for vulvar cancer in gynaecological cancer centres certified by the German Cancer Society (DKG)

PurposeIn 2018, the first guideline-based quality indicators (QI) for vulvar cancer were implemented in the data-sheets of certified gynaecological cancer centres. The certification process includes guideline-based QIs as a fundamental component. These indicators are specifically designed to evaluate the level of care provided within the centres. This article aims to give an overview of the developing process of guideline based-QIs for women with vulvar cancer and presents the QIs results from the certified gynaecological cancer centres.MethodsThe QIs were derived in a standardized multiple step process during the update of the 2015 S2k guideline “Diagnosis, Therapy, and Follow-Up Care of Vulvar Cancer and its Precursors” (registry-number: no. 015/059) and are based on strong recommendations.ResultsIn total, there are eight guideline-based QIs for vulvar cancer. Four QIs are part of the certification process. In the treatment year 2021, 2.466 cases of vulvar cancer were treated in 177 centres. The target values in the centres for pathology reports on tumour resection and lymphadenectomy as well as sentinel lymph nodes have increased since the beginning of the certification process and have been above 90% over the past three treatment years (2019–2021).DiscussionQIs based on strong guideline recommendations, play a crucial role in measuring and allowing to quantify essential aspects of patient care. By utilizing QIs, centres are able to identify areas for process optimization and draw informed conclusions. Over the years the quality of treatment of vulvar cancer patients measured by the QIs was improved. The certification system is continuously reviewed to enhance patient care even further by using the outcomes from QIs revaluation.

Identifying strategies to support implementation of interprofessional primary care teams in Nova Scotia: Results of a survey and knowledge sharing event

BackgroundInterprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada.MethodsHealthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning.ResultsIPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities.InterpretationThis research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients.

Research on Corporate Financial Risk Management and Countermeasures

In today's new economic environment, competition among businesses is intensifying, leading to various challenges across industries. Financial risks, in particular, are receiving significant attention due to their potential impact. These risks can stem from market fluctuations, policy changes, or poor management, among other factors. Therefore, it's crucial for businesses to comprehensively consider and effectively manage these risks to ensure long-term stability and growth. Furthermore, controlling financial risks entails multiple measures. Businesses need to establish robust financial management systems, including clear financial goals, standardized financial processes, and well-defined internal control mechanisms. Additionally, they should enhance monitoring and analysis of market and industry dynamics to promptly identify and address potential risks. Moreover, by establishing reasonable financial budgets and funding plans and appropriately allocating financial resources, businesses can mitigate operational risks.

Co-creation of a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in Mopani District, Limpopo Province: nominal group technique.

Effective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study. Key stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1-5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback. Eleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement. The successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

Current Oncology Nutrition Care Practice in Southeast Asia: A Scoping Review

Although evidence-based nutrition care is recommended for patients with cancer, current nutrition care practices provided by nutritionists and dietitians in Southeast Asian countries are not clearly reported. The aim of this scoping review was to describe nutritionists’ and dietitians’ current oncology nutrition care practice within Southeast Asia by identifying access to dietetic services, tools or strategies used in providing care, and barriers and enablers to implementing nutrition care practices. Five databases (Ovid MEDLINE, Global Health, Embase, Cochrane Central Register of Controlled Trials, and Proquest) were searched through structured search strategies, in addition to strategic searching of grey literature. A total of 4261 sources of evidence were retrieved. After full-text screening, 18 studies from Southeast Asian countries met the inclusion criteria and were included in this review. The provision and reporting of nutrition care practices provided by nutritionists and dietitians were limited. Access to dietetic services, including nutritional screening tools and reason to be referred, were varied within studies. Barriers and enablers to nutrition care provision were unique and related to each country’s specific resources and guidelines. In summary, there was varied reporting of nutrition care practices provided to patients with cancer in Southeast Asia and a lack of clarity on the actual standardized processes. Future research is warranted to further explore the barriers and enablers to providing nutrition care by local nutritionists and dietitians in Southeast Asia.