Search Results (84)

Background: Type B Aortic Dissection (TBAD) management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in National Health Services (NHSs). Bridging the gap between Emergency Medicine (EM) and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improve outcomes and reduce mortality. Methods: A cross-sectional survey of EM consultants yielded n = 173 valid responses from n = 33 units across the UK. Subgroup analyses were conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland–Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to a rapid Computed Tomography Angiogram (CTA) was 70% (95% CI: 63.3–76.8%, p < 0.001), while 32% had standard operating procedures (SOPs) for TBAD (95% CI: 25.3–39.1%), and 26% were aware of any decision tool (95% CI: 20.6–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with a reported bias of 23.58% (−38.20% to 85.36%) (p = 0.02). Conclusions: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks. Furthermore, upon recognition of the most prevalent factors, CTA and specialist referral is advocated. Full article

Background and Objectives: Usual interstitial pneumonia (UIP) is associated with progressive fibrosing interstitial lung diseases (PF-ILD) and poor survival in patients with fibrosing interstitial lung disease (FILD). We aimed to investigate the predictors of PF-ILD and survival in patients with FILD-UIP. Materials and Methods: This retrospective study was conducted at a single, tertiary hospital in China. Patients underwent routine follow-up visits every 3 to 6 months according to standard operating procedures (SOPs). Patients with FILD-UIP were further stratified using the proposed PF-ILD criteria. Results: This retrospective study enrolled 150 patients with FILD-UIP between October 2020 and June 2025, with 117 patients completing follow-up for more than 12 months. FILD-UIP was categorized as idiopathic pulmonary fibrosis (IPF) (n = 67) and non-IPF-UIP (n = 50), which included connective tissue disease-associated UIP (n = 29), hypersensitivity pneumonitis-associated UIP (n = 7), and interstitial pneumonia with autoimmune features-associated UIP (n = 14). During the follow-up period, 32 (47.8%) patients with IPF and 19 (38.0%) non-IPF-UIP experienced PF-ILD. Pulmonary hypertension (PH) and predicted percentage of forced vital capacity (FVC%pred) were dependent risk factors for PF-ILD in patients with FILD-UIP, non-IPF-UIP, and IPF. King’s Brief Interstitial Lung Disease (KBILD) is a dependent risk factor for PF-ILD in patients with FILD-UIP and IPF. PF-ILD is similarly associated with poor survival in patients with FILD-UIP, non-IPF-UIP, and IPF. Conclusions: Baseline disease severity is closely associated with the incidence of PF-ILD, with all forms of FILD-UIP at risk of PF-ILD and showing similar outcomes to IPF-UIP/PF-ILD. Full article

Standard operating procedures (SOPs) serve as critical control mechanisms in manufacturing systems, yet systematic approaches for quantifying procedural inefficiencies remain theoretically underdeveloped. Unlike traditional qualitative SOP analysis methods that rely on expert intuition and subjective assessment, current procedural optimization approaches lack the systematic rigor applied to physical process improvement. While lean manufacturing principles have demonstrated effectiveness in physical process optimization, their systematic application to procedural analysis represents an unexplored theoretical domain with significant potential for manufacturing systems improvement. This research addresses this gap by developing the Procedural Waste Index (PWI) framework, which establishes the first systematic theoretical integration of lean waste identification principles with procedural analysis. The framework extends the seven wastes of lean manufacturing to procedural analysis through systematic mapping to procedural elements identified via the extended Procedure Representation Language (e-PRL), creating a quantitative approach that enables the objective measurement of procedural efficiency where only subjective assessment methods previously existed. The PWI framework provides the following three key advantages over existing approaches: (1) systematic waste identification using proven lean principles rather than ad hoc improvement methods, (2) quantitative measurement capability enabling objective assessment and statistical process control, and (3) multi-perspective analytical framework through three complementary calculation methodologies (weighted aggregation, maximum constraint identification, and root mean square analysis) providing comprehensive analytical perspectives on procedural waste across discrete manufacturing contexts. The theoretical framework demonstrates practical applicability through a systematic analysis of a respirator fit testing procedure, revealing inventory waste as the primary inefficiency (70.0% waste score). This represents the first quantitative procedural waste assessment in the manufacturing literature, contributing to the foundational theory for systematic procedural optimization while establishing a methodology for future empirical validation studies. Full article

Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article

The Black Sea is a semi-enclosed basin subject to intense anthropogenic pressures and transboundary pollution, making reliable and comparable monitoring data essential for large-scale environmental assessments. However, national practices differ considerably, hindering data integration and coordinated reporting under international frameworks. This study, conducted within the Horizon 2020 project “Advancing Black Sea Research and Innovation to Co-develop Blue Growth within Resilient Ecosystems” (BRIDGE-BS), evaluated pollutant surveillance methodologies with a focus on heavy metals and priority organic contaminants (polycyclic aromatic hydrocarbons, polychlorinated biphenyls, organochlorine pesticides). Standard Operating Procedures (SOPs) were collected from institutions across Black Sea countries and systematically compared for water, sediment, and biota matrices. The analysis revealed shared reliance on internationally recognized techniques but also heterogeneity in sediment fraction selection, digestion and extraction conditions, instrumental approaches, and quality assurance/quality control (QA/QC) documentation. To complement this assessment, an intercalibration (IC) exercise was organized through the QUASIMEME proficiency testing scheme, accompanied by a follow-up structured questionnaire sent to participant institutions. While individual results remain confidential, collective feedback highlighted common challenges in calibration, blank correction, certified reference materials (CRMs) availability, digestion variability, instrument maintenance, and the reporting of uncertainty and detection limits. Together, these findings confirm that harmonization in the Black Sea requires not only improved comparability of laboratory methods but also the future alignment of assessment methodologies, including indicators and thresholds, to support coherent, basin-wide environmental evaluations under regional conventions and EU directives. Full article

Background: Intravenous vancomycin is a mainstay for prosthetic joint infections, osteomyelitis, and implant-associated infections, yet real-world dosing frequently misses PK/PD targets. We assessed whether a ward-embedded standard operating procedure (SOP) improves target attainment and dosing efficiency. Methods: Single-centre, non-randomized pre-post study in an orthopedic service. SOP mandated weight-adapted loading dose, renal function-adjusted maintenance dosing, a 15–20 mg/L trough target, and scheduled TDM. Adults receiving ≥72 h IV vancomycin were included; major renal failure and incomplete TDM were excluded. Pre-SOP data were retrospective; post-SOP data were prospective (03/2024–06/2025). Primary outcome: proportion of troughs within 15–20 mg/L (first and repeated). Repeated measures were modeled with GEE. Time to first in-range trough used Kaplan–Meier (indexed by measurement number). Results: We included 154 patients (pre-SOP n = 58; post-SOP n = 96); baseline characteristics were broadly similar. Use of a weight-based loading dose rose from 31.0% pre-SOP to 100% post-SOP (p < 0.001). At the first trough, 17.2% vs. 26.0% were within 15–20 mg/L (p = 0.238). Across 847 troughs (pre = 319; post = 528), the in-range proportion increased from 28.2% to 41.7%, with subtherapeutic values declining from 38.2% to 26.3% and supratherapeutic values remaining nearly similar (33.5% → 32.0%). Time to first in-range trough shortened from a median of 4 to 2 measurements (log-rank p < 0.001). Post-SOP measurements had higher odds of being in range (aOR 1.68, 95% CI 1.29–2.20; p < 0.001), with marginal predicted probabilities of 33.4% (pre) vs. 47.8% (post). Dose adjustments per patient decreased from a mean 4.0 to 2.48 (p < 0.001). Conclusions: A pragmatic, orthopedic ward–embedded SOP for intravenous vancomycin improved pharmacologic precision: more measurements within target, fewer subtherapeutic exposures, faster target attainment, and fewer dose changes. These data support protocol-first implementation as an immediately actionable step toward more consistent vancomycin exposure in orthopedic care. Future work should integrate AUC-guided, model-informed precision dosing and evaluate clinical endpoints and generalizability across centres. Full article

This study investigates the determinants of service demand in the packaging and printing industry, identifying 19 key factors through expert evaluation. These factors were analyzed using the Importance–Satisfaction (I–S) Model to pinpoint areas requiring enhancement, with four elements classified within the improvement zone. Considering resource constraints, improvement priorities were established through a modified Risk Priority Number (RPN) framework derived from Failure Modes and Effects Analysis (FMEA), expressed as RPN = I × F × E. The highest-priority areas for improvement included product pricing, flexibility in meeting customer requirements, suppliers’ emergency response capabilities, and proactive communication regarding raw material price fluctuations. The findings indicate that consumers balance price against sustainability value, highlighting the necessity of setting prices that align with perceived value to sustain trust and meet expectations. Strengthening firms’ emergency response mechanisms and developing an online standard operating procedure (SOP) notification system for raw material price changes can enhance communication efficiency, increase transparency in pricing, and ultimately improve organizational competitiveness. Full article

Background: Febrile neutropenia (FN) is a common and potentially life-threatening complication in pediatric oncology. Rapid initiation of empiric antibiotics is critical to improving prognosis. This study evaluated the impact of simple changes to a standard operating procedure (SOP) for FN treatment on the time-to-antibiotic (TTA) in pediatric cancer patients, as well as potential clinical effects. Methods: In this retrospective, single-center, cohort study, children with cancer presenting with FN at the emergency room (pedER) or oncology outpatient department (OD) were included over two one-year periods—before and after SOP adaption. The revised SOP defined a target TTA of ≤30 min. The primary endpoint was to compare median TTA and the proportion of FN episodes meeting target TTA. Secondary endpoints comprised adverse events (AEs) (e.g., ICU admission, need for respiratory or circulatory support, sepsis criteria). Results: After SOP adaption, 32.9% of episodes met target TTA, up from 5.9% before. Median TTA was significantly reduced (44 min vs. 93 min). The improvement persisted during the study period. AE rates showed no significant change. Conclusions: Simple procedural adjustments may significantly improve quality indicators of care, e.g., reducing TTA in pediatric FN patients. These adjustments may be transferable to other pediatric oncology settings. Full article

Standard Operating Procedures (SOPs) serve a critical role in complex systems operations, guiding operator response during normal and emergency scenarios. This study compares 29 SOPs (517 steps) across three domains with varying operator selection rigor: airline operations, Habitable Airlock (HAL) operations, and semi-autonomous vehicles. Using the extended Procedure Representation Language (e-PRL) framework, each step was decomposed into perceptual, cognitive, and motor components, enabling quantitative analysis of step types, memory demands, and training requirements. Monte Carlo simulations compared Time on Procedure against the Allowable Operational Time Window to predict failure rates. The analysis revealed three universal vulnerabilities: verification steps missing following waiting requirements (70% in airline operations, 58% in HAL operations, and 25% in autonomous vehicle procedures), ambiguous perceptual cues (15–48% of steps), and excessive memory demands (highest in HAL procedures at 71% average recall score). Procedure failure probabilities varied significantly (5.72% to 63.47% across domains), with autonomous vehicle procedures showing the greatest variability despite minimal operator selection. Counterintuitively, Habitable Airlock procedures requiring the most selective operators had the highest memory demands, suggesting that rigorous operator selection may compensate for procedure design deficiencies. These findings establish that procedure design approaches vary by domain based on assumptions about operator capabilities rather than universal human factors principles. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background/Objectives: Dual task (DT) training consists of practicing exercises while simultaneously performing a concurrent motor or cognitive task. This training modality seems to have beneficial effects on both domains. Various forms of DT training have been implemented for older adults in recent years, but no official guidelines currently exist. This review sought to analyze the studies published on this topic in the last ten years and provide a standard operating procedure (SOP) for healthy older adults in this context. Methods: The review collected articles from PubMed, Web of Science, and Scopus, adopting a designated set of keywords. Selected manuscripts and relevant information were selected, extrapolated, including information related to the training frequency, intensity, time, and type, and secondary tasks adopted. The secondary tasks were grouped according to previously published studies, and the SOP was created based on the frequency of the parameters collected from the included articles. Results: A total of 44 studies were included in the review. Based on the results, the SOP recommends postural balance or resistance training as primary tasks, combined with a mental tracking task as a secondary component. Two 60-min sessions per week for at least 12 weeks are required to achieve measurable results. Conclusions: Despite heterogeneity in the literature reviewed, the findings support the proposal of a SOP to guide future research on DT training in healthy older adults. Given its feasibility and positive effects on both motor and cognitive functions, this type of training can also be implemented in everyday settings. Full article

Process anomaly detection in financial services systems is crucial for operational compliance and risk management. However, traditional process mining techniques frequently neglect the detection of significant low-frequency abnormalities due to their dependence on frequency and the inadequate incorporation of domain-specific knowledge. Therefore, we develop an enhanced process mining algorithm by incorporating a domain-specific follow-relationship matrix derived from standard operating procedures (SOPs). We empirically evaluated the effectiveness of the proposed algorithm based on real-world event logs from a corporate account-opening process conducted from January to December 2022 in a Chinese commercial bank. Additionally, we employed large language models (LLMs) for root cause analysis and process optimization recommendations. The empirical results demonstrate that the E-Heuristic Miner significantly outperforms traditional machine learning methods and process mining algorithms in process anomaly detection. Furthermore, the integration of LLMs provides promising capabilities in semantic reasoning and offers explainable optimization suggestions, enhancing decision-making support in complex financial scenarios. Our study significantly improves the precision of process anomaly detection in financial contexts by incorporating banking-specific domain knowledge into process mining algorithms. Meanwhile, it extends theoretical boundaries and the practical applicability of process mining in intelligent, semantic-aware financial service management. Full article

Wheelchair tennis (WT) is a Paralympic sport designed for athletes with physical impairments. Assessing physical fitness characteristics using appropriate field-based tests and standardized protocols is essential for individualized training, injury prevention, and performance monitoring. However, there is currently limited information on which field-based tests are most suitable and how they should be applied in WT athletes, resulting in inconsistency across studies and practical use. Establishing a standard operating procedure (SOP) enables replicable, cost-effective testing routines that improve data consistency and comparability. We conducted a scoping review to synthesize the existing evidence on field-based physical fitness assessment in WT athletes and to propose a structured SOP for these tests. A comprehensive search was conducted in three electronic databases—NLM PubMed, Web of Science, and Scopus—using predefined keywords and Boolean operators. The inclusion criteria were limited to peer-reviewed, English-language original articles focusing exclusively on field tests in WT athletes. Studies with other populations, reviews, and abstracts were excluded. Eleven studies met the eligibility criteria. This scoping review identified various field tests assessing key fitness components, including cardiorespiratory endurance, muscle strength, agility, and body composition. The most frequently employed tests were the 20 m sprint test, isometric handgrip test, spider test, Illinois Agility Test, and skinfold thickness. These findings highlight the lack of standardized fitness assessments in WT. The proposed SOP offers a practical step toward consistent, replicable, and relevant evaluation in these athletes. Full article

Inefficient material tracking continues to be a major challenge in sustainable construction, often leading to unnecessary waste, budget overruns, and project delays. While many digital tools have been introduced in recent years, there is still a lack of practical, field-tested frameworks that combine these technologies with clear, structured procedures, especially in resource-constrained environments. This study introduces a Standard Operating Procedure (SOP) framework designed to improve materials tracking systems (MTSs) by integrating QR codes, GPS tracking, and cloud-based dashboards. Together, these tools support more accurate planning, smoother coordination, and real-time monitoring from the early design stages to on-site implementation. A mixed-methods approach was used, combining surveys with construction professionals and focus group discussions with engineers, IT specialists, and logistics staff. The findings highlight procurement and implementation as the phases most prone to inefficiencies, particularly around material receiving, quality checks, and on-site placement. The validated SOP framework shows strong potential to improve tracking accuracy, reduce material waste, and streamline construction workflows. It offers a flexible, easy-to-use system for integrating sustainability into everyday project practices. Looking ahead, this study also points to future opportunities for applying AI-based tools—such as predictive tracking and automated quality checks—to further improve decision-making and resource efficiency in construction projects. Full article

Objective: Current good manufacturing practice (cGMP) guidance for positron emission tomography (PET) drugs has been established in Europe and the United States. In Japan, the Pharmaceuticals and Medical Devices Agency (PMDA) approved the use of radiosynthesizers as medical devices for the in-house manufacturing of PET drugs in hospitals and clinics, regardless of the cGMP environment. Without adequate facilities, equipment, and personnel required by cGMP regulations, the quality assurance (QA) and clinical effectiveness of PET drugs largely depend on the radiosynthesizers themselves. To bridge the gap between radiochemistry standardization and site qualification, the Japanese Society of Nuclear Medicine (JSNM) has issued guidance for the in-house manufacturing of small-scale PET drugs under academic GMP (a-GMP) environments. The goals of cGMP and a-GMP are different: cGMP focuses on process optimization, certification, and commercialization, while a-GMP facilitates the small-scale, in-house production of PET drugs for clinical trials and patient-specific standard of care. Among PET isotopes, N-13 has a short half-life (10 min) and must be synthesized on site. [¹³N]Ammonia ([¹³N]NH₃) is used for myocardial perfusion imaging under the Japan Health Insurance System (JHIS) and was thus selected as a working example for the manufacturing of PET drugs in an a-GMP environment. Methods: A [¹³N]NH₃-radiosynthesizer was installed in a hot cell within an a-GMP-compliant radiopharmacy unit. To comply with a-GMP regulations, the air flow was adjusted through HEPA filters. All cabinets and cells were disinfected to ensure sterility once a month. Standard operating procedures (SOPs) were applied, including analytical methods. Batch records, QA data, and radiation exposure to staff in the synthesis of [¹³N]NH₃ were measured and documented. Results: 2.52 GBq of [¹³N]NH₃ end-of-synthesis (EOS) was obtained in an average of 13.5 min in 15 production runs. The radiochemical purity was more than 99%. Exposure doses were 11 µSv for one production run and 22 µSv for two production runs. The pre-irradiation background dose rate was 0.12 µSv/h. After irradiation, the exposed dosage in the front of the hot cell was 0.15 µSv/h. The leakage dosage measured at the bench was 0.16 µSv/h. The exposure and leakage dosages in the manufacturing of [¹³N]NH₃ were similar to the background level as measured by radiation monitoring systems in an a-GMP environments. All QAs, environmental data, bacteria assays, and particulates met a-GMP compliance standards. Conclusions: In-house a-GMP environments require dedicated radiosynthesizers, documentation for batch records, validation schedules, radiation protection monitoring, air and particulate systems, and accountable personnel. In this study, the in-house manufacturing of [¹³N]NH₃ under a-GMP conditions was successfully demonstrated. These findings support the international harmonization of small-scale PET drug manufacturing in hospitals and clinics for future multi-center clinical trials and the development of a standard of care. Full article