Audit Program Research Articles

Exploration of Popular Music Audition Programs: From the Perspective of Endogenous Theory of Education

Exploration of Popular Music Audition Programs: From the Perspective of Endogenous Theory of Education

Association of Annual Intensive Care Unit Sepsis Caseload With Hospital Mortality From Sepsis in the United Kingdom, 2010-2016

Sepsis is associated with a high burden of inpatient mortality. Treatment in intensive care units (ICUs) that have more experience treating patients with sepsis may be associated with lower mortality. To assess the association between the volume of patients with sepsis receiving care in an ICU and hospital mortality from sepsis in the UK. This retrospective cohort study used data from adult patients with sepsis from 231 UK ICUs between 2010 and 2016. Demographic and clinical data were extracted from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme database. Data were analyzed from January 1, 2010, to December 31, 2016. Annual sepsis case volume in an ICU in the year of a patient's admission. Hospital mortality after ICU admission for sepsis assessed using a mixed-effects logistic model in a 3-level hierarchical structure based on the number of individual patients nested in years nested within ICUs. Among 273 001 patients included in the analysis, the median age was 66 years (interquartile range, 53-76 years), 148 149 (54.3%) were male, and 248 275 (91.0%) were White. The mean ICNARC-2018 illness severity score was 21.0 (95% CI, 20.9-21.0). Septic shock accounted for 19.3% of patient admissions, and 54.3% of patients required mechanical ventilation. The median annual sepsis volume per ICU was 242 cases (interquartile range, 177-334 cases). The study identified a significant association between the volume of sepsis cases in the ICU and mortality from sepsis; in the logistic regression model, hospital mortality was significantly lower among patients admitted to ICUs in the highest quartile of sepsis volume compared with the lowest quartile (odds ratio [OR], 0.89; 95% CI, 0.82-0.96; P = .002). With volume modeled as a restricted cubic spline, treatment in a larger ICU was associated with lower hospital mortality. A lower annual volume threshold of 215 patients above which hospital mortality decreased significantly was found; 38.8% of patients were treated in ICUs below this threshold volume. There was no significant interaction between ICU volume and severity of illness as described by the ICNARC-2018 score (β [SE], -0.00014 [0.00024]; P = .57). The findings suggest that patients with sepsis in the UK have higher odds of survival if they are treated in an ICU with a larger sepsis case volume. The benefit of a high sepsis case volume was not associated with the severity of the sepsis episode.

Analysis of the RBA implementation and the preparation of an audit program at the Ministry of Villages, Development of Disadvantaged Regions and Transmigration

Risk-Based Audit (RBA) is an audit method that applies a risk approach in its implementation. By applying the RBA method, it is expected that an audit can be performed effectively and efficiently, thus producing maximum audit results. This study aims to analyze the implementation of RBA upon audits conducted by The Audit Board of Indonesia (BPK). Furthermore, this study analyzes the preparation of an Audit Program in line with the previously determined RBA. The research framework uses Agency Theory which emphasizes the relationship between management and principal. To ensure that management does not perform any manipulation, an independent third party must conduct the audit. This study applied a qualitative research methodology with a case study approach at BPK. The author expects to dig deeper into the application and implementation of RBA within BPK by using the case study approach support by audit documents and interviews with BPK Audit Team. The results showed that the implementation, performance, and monitoring of RBA by the BPK Audit Team were in line with the instructions and guidelines set by BPK.

Mortality and critical care unit admission associated with the SARS-CoV-2 lineage B.1.1.7 in England: an observational cohort study

SummaryBackgroundA more transmissible variant of SARS-CoV-2, the variant of concern 202012/01 or lineage B.1.1.7, has emerged in the UK. We aimed to estimate the risk of critical care admission, mortality in patients who are critically ill, and overall mortality associated with lineage B.1.1.7 compared with non-B.1.1.7. We also compared clinical outcomes between these two groups.MethodsFor this observational cohort study, we linked large primary care (QResearch), national critical care (Intensive Care National Audit & Research Centre Case Mix Programme), and national COVID-19 testing (Public Health England) databases. We used SARS-CoV-2 positive samples with S-gene molecular diagnostic assay failure (SGTF) as a proxy for the presence of lineage B.1.1.7. We extracted two cohorts from the data: the primary care cohort, comprising patients in primary care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 26, 2021, and known SGTF status; and the critical care cohort, comprising patients admitted for critical care with a positive community COVID-19 test reported between Nov 1, 2020, and Jan 27, 2021, and known SGTF status. We explored the associations between SARS-CoV-2 infection with and without lineage B.1.1.7 and admission to a critical care unit (CCU), 28-day mortality, and 28-day mortality following CCU admission. We used Royston-Parmar models adjusted for age, sex, geographical region, other sociodemographic factors (deprivation index, ethnicity, household housing category, and smoking status for the primary care cohort; and ethnicity, body-mass index, deprivation index, and dependency before admission to acute hospital for the CCU cohort), and comorbidities (asthma, chronic obstructive pulmonary disease, type 1 and 2 diabetes, and hypertension for the primary care cohort; and cardiovascular disease, respiratory disease, metastatic disease, and immunocompromised conditions for the CCU cohort). We reported information on types and duration of organ support for the B.1.1.7 and non-B.1.1.7 groups.FindingsThe primary care cohort included 198 420 patients with SARS-CoV-2 infection. Of these, 117 926 (59·4%) had lineage B.1.1.7, 836 (0·4%) were admitted to CCU, and 899 (0·4%) died within 28 days. The critical care cohort included 4272 patients admitted to CCU. Of these, 2685 (62·8%) had lineage B.1.1.7 and 662 (15·5%) died at the end of critical care. In the primary care cohort, we estimated adjusted hazard ratios (HRs) of 2·15 (95% CI 1·75–2·65) for CCU admission and 1·65 (1·36–2·01) for 28-day mortality for patients with lineage B.1.1.7 compared with the non-B.1.1.7 group. The adjusted HR for mortality in critical care, estimated with the critical care cohort, was 0·91 (0·76–1·09) for patients with lineage B.1.1.7 compared with those with non-B.1.1.7 infection.InterpretationPatients with lineage B.1.1.7 were at increased risk of CCU admission and 28-day mortality compared with patients with non-B.1.1.7 SARS-CoV-2. For patients receiving critical care, mortality appeared to be independent of virus strain. Our findings emphasise the importance of measures to control exposure to and infection with COVID-19.FundingWellcome Trust, National Institute for Health Research Oxford Biomedical Research Centre, and the Medical Sciences Division of the University of Oxford.

Addressing a system failure to diagnose COPD and asthma

To provide high-quality guideline-based care for patients with asthma or chronic obstructive pulmonary disease (COPD) we must first establish the correct diagnosis. The National Asthma and COPD Audit Programme (NACAP) has highlighted an important issue across England, Scotland, and Wales that potentially undermines care for many people with airways disease.

Do Electronic Health Record Systems Increase Medicare Reimbursements? The Moderating Effect of the Recovery Audit Program

Electronic health record (EHR) systems allow physicians to automate the process of entering patient data relative to manual entry in traditional paper-based records. However, such automated data entry can lead to increased reimbursement requests by hospitals from Medicare by overstating the complexity of patients. The EHR module that has been alleged to increase reimbursements is the Computerized Physician Order Entry (CPOE) system, which populates patient charts with default templates and allows physicians to copy and paste data from previous charts of the patient and other patients’ records. To combat increased reimbursements by hospitals from Medicare, the Centers for Medicare & Medicaid Services implemented the Recovery Audit Program first as a pilot in six states between 2005 and 2009 and then, nationwide in the entire United States in 2010. We examine whether the adoption of CPOE systems by hospitals is associated with an increase in reported patient complexity and if the Recovery Audit Program helped to attenuate this relationship. We find that the adoption of CPOE systems significantly increases patient complexity reported by hospitals, corresponding to an estimate of $1 billion increase in Medicare reimbursements per year. This increase was attenuated when hospitals were regulated by the Recovery Audit Program. Notably, those recovery auditors who developed the ability to identify the use of default templates, copied and pasted data, and cloned records were the most effective in reducing increased reimbursements. These findings have implications on how to combat Medicare reimbursements paid by taxpayer dollars with the Recovery Audit Program and how this information technology (IT) audit can prevent the misuse of information systems to create artificial business value of IT by hospitals. Contributions to information systems and healthcare research, practice, and public policy are discussed. This paper was accepted by Chris Forman, information systems.

803-P: The Association between Empagliflozin and Changes in Alanine Aminotransferase Levels: Data from the Association of British Clinical Diabetologists (ABCD) Audit Programme

Background: Nonalcoholic fatty liver disease (NAFLD) commonly co-exists with type 2 diabetes. Alanine aminotransferase (ALT) levels are known to correlate, to some degree, with liver inflammation. Methods: All data submitted to the ABCD nationwide empagliflozin audit programme were included if they had relevant baseline and follow-up data and were then stratified by baseline ALT for two analyses: 1) using gender-specific reference ranges; 2) by normal ( Results: 6510 datasets were included with mean(±SD) age 60.0yrs(±10.4), 61.2% male, BMI 34.2kg/m2(±6.5), HbA1c 9.3%(±1.6) and weight 98.4kg(±21.23). For the entire population, median ALT changed by -4 U/L (95% CI -4, -4; P Conclusion: Our data demonstrate changes in ALT associated with empagliflozin use. Decreases of a significantly greater magnitude are noted in those with raised ALT at baseline. Empaglifozin may provide benefit in NAFLD. Disclosure T. S. J. Crabtree: Other Relationship; Self; Novo Nordisk, Sanofi. J. Elliott: Advisory Panel; Self; Abbott, Speaker’s Bureau; Self; Abbott, Dexcom, Inc., Insulet Corporation, Novo Nordisk. A. Bickerton: None. I. W. Gallen: None. K. Dhatariya: Speaker’s Bureau; Self; Novo Nordisk. M. L. Cull: None. A. Evans: None. S. M. Phillips: None. R. E. Ryder: Other Relationship; Self; Novo Nordisk. Funding Boehringer Ingelheim

1036-P: Ethnic Discordance between HbA1c and BP Management in Primary Care among New Zealanders with Type 2 Diabetes

Hospitalization has been higher among New Zealand (NZ) Māori and Pasifika than Europeans with type 2 diabetes (T2DM) for >20 years. We compared their metabolic profiles as possible drivers behind the worse outcomes.Methods: We identified four 5-year cohorts incorporating 15498 Europeans, 6445 Māori 10294 Pasifika with T2DM enrolled in 1994, 1999, 2004, 2009, to a primary care audit program. Systolic blood pressure (SBP), body mass index (BMI), HbA1c, albumin creatinine ratio (ACR), total cholesterol (TC), and triglyceride were measured at baseline, 1, 2, 3, 4 and 5-years. Mean and mean-difference (reference= European) were estimated at each time-point, with adjustment for age, gender, smoking, SE status, diabetes duration, key meds and the other measures. Multiple imputation with chained equation tackled missing values. Multivariable mixed effects modelling was used to model the repeated measurements.Results: Compared with Europeans, Māori (black) and Pasifika (grey) had higher HbA1c, ACR, and lower SBP at each time-point and within each cohort. Fig 1 shows the adjusted mean (95%CI) differences.Conclusions: NZ Māori/Pasifika under primary care management have better SBP and lipids, but worse glycemia than Europeans. This could partly explain the worse Māori/Pasifika outcomes and suggests that glycemic management is more challenging than BP/lipid management for primary care.View largeDownload slideView largeDownload slide DisclosureD. Simmons: None. D. Yu: None. R. G. Cutfield: None. B. J. Orr-walker: None. Z. Zhao: None. Y. Cai: None. C. Hotu: None. J. Baker: None. U. L. Osuagwu: None.FundingCounties Manukau Health; Middlemore Foundation

Regulatory requirements, logistics and challenges of conducting an effective field audit programme

This paper reviews internal compliance examinations for broker-dealers and investment advisers in the light of emerging work trends and regulatory guidance stemming from the coronavirus pandemic. It pays special attention to internal compliance practices, the use of technology and staffing needs before examining factors for firms to consider in determining whether to conduct internal examinations remotely or on-site. It pays particular attention to branch-office examinations. The paper concludes that the most successful firms in adapting to changing workplace conditions and regulatory guidance not only will remain at the forefront of compliance but also can drive their own business forwards.

Effect of empagliflozin on albuminuria, eGFR and serum creatinine: updated results from the ABCD nationwide empagliflozin audit

Introduction: Evidence from phase III and the EMPA-REG OUTCOME trials have demonstrated improvements in renal endpoints with empagliflozin use. The EMPA-KIDNEY trial is currently underway and is assessing whether there are benefits of empagliflozin in improving renal outcomes in people both with and without diabetes, and the mechanism has been suggested to be similar to that of ACE inhibitors with the haemodynamic effects of sodium-glucose co-transporter-2 inhibition reducing intraglomerular pressure.Aim: To assess the impacts of empagliflozin use on albuminuria and estimated glomerular filtration rate (eGFR) in a real-world UK-based audit.Methods: Data were collated via the ABCD nationwide audit programme, with analyses performed using either t-tests/ ANOVA or Wilcoxon signed rank/Kruskal–Wallis tests. Pre-specified stratified subgroup analyses by baseline eGFR and baseline albuminuria levels were also performed.Results: Our results demonstrated significant reductions in albuminuria across the population as a whole. When stratified by baseline albuminuria levels, those with microalbuminuria (30–300 μg/mg) or macroalbuminuria (>300 μg/mg) had significant improvements in urine albumin levels at 6-month (3–9-month) follow-up, with median changes of −17.7 μg/mg (p<0.0001; 95% CI −17.4 to −23.7) and 379.4 μg/mg (p=0.03; 95% CI −269.9 to −725.4), respectively. Across the population as a whole, eGFR reduced initially (at 6 months, −1.26 mL/min/1.73 m3; p<0.0001; 95% CI −0.87 to −1.64) before recovering to baseline by 24 months. When stratified by baseline eGFR, those with reduced renal function (eGFR <90) recovered quickest, with improvements in eGFR noted from baseline by 24 months.Conclusion: In this real-world analysis, the results are comparable to those in randomised controlled trials and are likely more generalisable to UK clinical practice. Unfortunately, we do not have clinical endpoints such as end-stage renal failure, renal death or dialysis as part of our dataset. Future audits could consider including these data to establish clinical as well as biochemical outcomes.

Monte Carlo verification of the holder correction factors for the radiophotoluminescent glass dosimeter used by the IAEA in international dosimetry audits.

The International Atomic Energy Agency (IAEA), jointly with the World Health Organization (WHO), has operated a postal dosimetry audit program for radiotherapy centers worldwide since 1969. In 2017 the IAEA introduced a new methodology based on radiophotoluminescent dosimetry (RPLD) for these audits. The detection system consists of a phosphate glass dosimeter inserted in a plastic capsule that is kept in measuring position with a PMMA holder during irradiation. Correction factors for this holder were obtained using experimental methods. In this work these methods are described and the resulting factors are verified by means of Monte Carlo simulation with the general-purpose code PENELOPE for a range of photon beam qualities relevant in radiotherapy. The study relies on a detailed geometrical representation of the experimental setup. Various photon beams were obtained from faithful modeling of the corresponding linacs. Monte Carlo simulation transport parameters are selected to ensure subpercent accuracy. The simulated correction factors fall in the interval 1.005-1.008 (±0.2%), with deviations with respect to experimental values not larger than 0.2(2)%. This study corroborates the validity of the holder correction factors currently used for the IAEA audits.

Accuracy of Hemodialysis Bloodstream Infection Pathogen Reporting to the National Healthcare Safety Network: Results of an Academic Dialysis Program Audit

Patients with dialysis-dependent end-stage kidney disease experience high rates of infections.1 Bloodstream infections (BSIs) are the major cause of fatal infection and third leading cause of death.1 Since 1999, the Centers for Disease Control and Prevention has tracked dialysis infections by facility self-reporting to the National Healthcare Safety Network (NHSN).2 Maintaining accurate BSI data is necessary to inform infection prevention efforts. BSI rates also affect the Patient Safety domain of the Quality Incentive Program, negatively affecting facility revenue.

What Gets Measured Gets Improved-Setting Standards and Accreditation for Quality Improvement for Diabetes Services in Australia.

The purpose of this article is to illustrate that setting standards of care is the cornerstone for excellence in diabetes management. This is underpinned by 3 activities: a standards and accreditation process, an audit and benchmarking program and a linked quality improvement plan. While there are many examples of local auditing and quality improvement programs, there are very few that are at a national level. The National Association of Diabetes Centres (NADC) was formed by the Australian Diabetes Society and the Australian Diabetes Educators Association to set standards of diabetes care in Australia. A rigorous accreditation process was put in place to recognize primary, secondary, and tertiary level diabetes centers that meet these standards. The NADC accreditation process is underpinned by a quality improvement plan, which must be submitted for accreditation to be granted and is informed by the Australian National Diabetes Audit (ANDA). ANDA is conducted annually to gather information about treatments, complications, self-care practices and quality of life outcomes and provides a national as well as an individual report to the participating center that is used to benchmark against other like centers. The ANDA reports are important to inform national policy and advocacy for diabetes care and to also provide information for quality improvement purposes for the individual participating center. We believe that the NADC Standards and Accreditation can be an exemplar for other countries to adapt and adopt to standardize diabetes care at the highest level.

Exploring Determinants of Digital Music Success

This study investigated the determinants of digital music success. We identified information sources and factors that may influence the consumption of digital music in both the short and longer term: song and artist characteristics, stakeholder influence, and promotional media influence. First, we found that traditional promotional media, such as number of television or radio exposures and appearance on an audition program, significantly affected both short- and longer-term success. Second, regarding social promotional media factors, online teaser videos affected only short-term digital music success; online music videos impacted only longer-term success. Third, an artist having had a long career positively affected a song’s early success; frequent song releases had a negative impact. Our results offer marketers an insight into promoting digital music.

The importance of reducing the risks of electronic auditing in improving the business performance of commercial banks : A prospective study on commercial banks registered in the Iraqi Stock Exchange

This topic is considered one of the important topics in order to improve the financial situation of commercial banks through of the expansion of banking services. Therefore, the research aims to identify the relationship between the independent variable, the risks of electronic audit, and the dependent variable in improving banking performance and to identify the extent of awareness of workers in commercial banks (in question) of the concept of electronic auditing risks. The deductive method based on statistical measurement tools has been used in scientific research by using a questionnaire to find out the opinions of a sample of workers in commercial banks, which are (5) banks, (110) questionnaire forms have been distributed on the aforementioned sample, (100) questionnaires have been retrieved from them for statistical analysis and identification of the results. The research has reached some important conclusions: there is a tangible weakness in the use of electronic auditing programs by auditors, and this contributes to the poor performance of banks ’work. The most important research recommendations is the need for commercial banks to choose competent auditors in developing and managing electronic audit programs to prevent errors and Travesties.

The role of electronic auditing in verifying the principles and approaches of accounting measurement for financial instruments when adopting international financial reporting standards IFRS

The diversity of financial assets owned by Iraqi companies, which are measured and presented in different ways according to the classification of these assets according to international financial reporting standards, and that re-measuring these assets (shares) affects the income statement and the financial position of companies according to the change in the fair value of shares. The auditor uses multiple auditing methods for the purpose of verifying the measurement and presentation of these assets, including the use of electronic means in auditing (computer auditing.(The aim of the research is to clarify what electronic auditing is and to explain and analyse the measurement requirements in accordance with the International Financial Reporting Standard (IFRS - 9), in addition to preparing an electronic audit program that helps the auditor to verify the re measurement and presentation of the companies ’financial assets. Two mixed joint stock companies (Iraqi Company for Manufacturing and Marketing Dates - the National Company for Tourism Investments and Real Estate Projects) are adopted as a field of application by analysing their financial data for the year / 2018 and conducting a simulation of the outcome of the activity and the financial position of the company using an electronic audit program. This is to show the difference between the actual results and the results expected to be shown in light of the measurement principles adopted under international financial reporting standards. The researchers have concluded that the use of electronic means helps the auditor to conduct the audit process for the various financial assets due to their multiplicity and diversity in addition to the diversity of their market values. In addition, this enables the auditor to identify errors and indicate their impact on the income statement and budget and thus reach a final opinion on the financial statements towards the use of electronic means in auditing operations by professional organizations and relevant authorities for the purpose of speed and accuracy in completing auditing operations. Moreover, the necessity to prepare electronic programs for various auditing purposes in line with the activity of the bodies subject for auditing and training auditors in the use of such programs.

Outcomes following PCI in CABG candidates during the COVID-19 pandemic: The prospective multicentre UK-ReVasc registry.

ObjectivesTo describe outcomes following percutaneous coronary intervention (PCI) in patients who would usually have undergone coronary artery bypass grafting (CABG).BackgroundIn the United Kingdom, cardiac surgery for coronary artery disease (CAD) was dramatically reduced during the first wave of the COVID‐19 pandemic. Many patients with “surgical disease” instead underwent PCI.MethodsBetween 1 March 2020 and 31 July 2020, 215 patients with recognized “surgical” CAD who underwent PCI were enrolled in the prospective UK‐ReVasc Registry (ReVR). 30‐day major cardiovascular event outcomes were collected. Findings in ReVR patients were directly compared to reference PCI and isolated CABG pre‐COVID‐19 data from British Cardiovascular Intervention Society (BCIS) and National Cardiac Audit Programme (NCAP) databases.ResultsReVR patients had higher incidence of diabetes (34.4% vs 26.4%, P = .008), multi‐vessel disease with left main stem disease (51.4% vs 3.0%, P < .001) and left anterior descending artery involvement (94.8% vs 67.2%, P < .001) compared to BCIS data. SYNTAX Score in ReVR was high (mean 28.0). Increased use of transradial access (93.3% vs 88.6%, P = .03), intracoronary imaging (43.6% vs 14.4%, P < .001) and calcium modification (23.6% vs 3.5%, P < .001) was observed. No difference in in‐hospital mortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS 0.7%, P = .19; vs NCAP 1.0%, P = .48). Inpatient stay was half compared to CABG (3.0 vs 6.0 days). Low‐event rates in ReVR were maintained to 30‐day follow‐up.ConclusionsPCI undertaken using contemporary techniques produces excellent short‐term results in patients who would be otherwise CABG candidates. Longer‐term follow‐up is essential to determine whether these outcomes are maintained over time.

Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness

BackgroundThe United States Department of Veterans Affairs established a program in which actors incognito portray veterans experiencing homelessness with pre-determined needs to identify barriers to access and services at community-based organizations.MethodsFrom 2017 to 2019, actors who varied in gender, skin color and age portrayed one of three scripts at all VA Community-Based Resource and Referral Centers (CRRCs) serving veterans experiencing homelessness in 30 cities and completed an evaluative survey. They carried authentic VA identification and were registered in a VA patient database for each identity. CRRCs were provided with reports annually and asked to implement corrective plans. Data from the survey were analysed for change over time.ResultsAccess to food, counselling, PTSD treatment, and hypertension/prediabetes care services increased significantly from 68–77% in year 2 to 83–97% in year 3 (each P < 0.05 adjusted for script present). A significant disparity in access for African American actors resolved following more uniform adherence to pre-existing policies.ConclusionsThe ‘unannounced standardized veteran’ (USV) can identify previously unrecognized barriers to needed services and care. Audit and feedback programs based on direct covert observation with systematic data collection and rapid feedback may be an effective strategy for improving services to highly vulnerable populations.

Adenoma and Serrated Lesion Detection by Colonoscopy Indication: The ADR-ESS (ADR Extended to all Screening/Surveillance) Score

The adenoma detection rate at screening (ADR) predicts interval colorectal cancer. Monitoring other lesion detection rates and colonoscopy indications has been proposed. We developed a comprehensive, automated colonoscopy audit program based on standardized clinical documentation, explored detection rates across indications, and developed the Adenoma Detection Rate - Extended to all Screening / Surveillance (ADR-ESS) score. In a prospective cohort study, we calculated overall and advanced adenoma and sessile serrated lesion (SSL) detection rates among 15,253 colonoscopies by 35 endoscopists from 4 endoscopy units across all colonoscopy indications. We explored correlations between detection rates, and the precision and stability of ADR-ESS versus ADR. The overall "screening, first" ADR was 36.3% (95% confidence interval [CI], 34.5%-38.1%). The adenoma detection rate was lower for "screening, not first" (relative rate [RR], 0.80; 95% CI, 0.74-0.87) and "family history" (RR, 0.84; 95% CI, 0.74-0.96), and higher for "surveillance" (RR, 1.22; 95% CI, 1.15-1.31) and "follow-up, FIT" (RR, 1.21; 95% CI, 1.07-1.37). For "screening, first," the detection rates for advanced adenoma, SSL, and advanced SSL were 6.7% (95% CI, 5.7%-7.7%), 7.2% (95% CI, 6.2%-8.2%), and 2.6% (95% CI, 2.0%-3.2%), respectively. Adenoma and SSL detection were correlated (r= 0.44; P= .008). ADR-ESS had substantially narrower confidence intervals and less period-to-period variability than ADR, and was not improved by weighting for indication volume and correction for detection by indication. Comprehensive, automated colonoscopy audit based on standardized clinical documentation is feasible. Adenoma detection is a fair but imperfect proxy for SSL detection. ADR-ESS increases the precision of adenoma detection assessments and emphasizes quality across colonoscopy indications.

Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance.

BackgroundThere have been concerns that the COVID-19 pandemic may lead to an increase in suicide. The coronial system in England is not suitable for timely monitoring of suicide because of the delay of several months before inquests are held.MethodsWe used data from established systems of "real time surveillance" (RTS) of suspected suicides, in areas covering a total population of around 13 million, to test the hypothesis that the suicide rate rose after the first national lockdown began in England.FindingsThe number of suicides in April-October 2020, after the first lockdown began, was 121•3 per month, compared to 125•7 per month in January-March 2020 (-4%; 95% CI-19% to 13%, p = 0•59). Incidence rate ratios did not show a significant rise in individual months after lockdown began and were not raised during the 2-month lockdown period April-May 2020 (IRR: 1•01 [0•81–1•25]) or the 5-month period after the easing of lockdown, June-October 2020 (0•94 [0•81–1•09]). Comparison of the suicide rates after lockdown began in 2020 for the same months in selected areas in 2019 showed no difference.InterpretationWe did not find a rise in suicide rates in England in the months after the first national lockdown began in 2020, despite evidence of greater distress. However, a number of caveats apply. These are early figures and may change. Any effect of the pandemic may vary by population group or geographical area. The use of RTS in this way is new and further development is needed before it can provide full national data.FundingThis study was funded by the Healthcare Quality Improvement Partnership (HQIP).The HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programs and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Program (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The program is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations, and crown dependencies.