Audit Review Research Articles

The Impact of Clinical Pharmacist-Driven Weekend Antimicrobial Stewardship Coverage at a Quaternary Hospital.

Extending a consistent pharmacy antimicrobial stewardship weekend service was a newly implemented initiative. We sought to evaluate the impact of incorporating an Infectious Diseases (ID)-trained clinical pharmacist into an antimicrobial stewardship program (AMS) during weekends. The number of documented interventions was 451 on 362 patients compared to 115 interventions on 108 patients during the pre-implementation period (p = 0.04), with interventions primarily targeting Watch antibiotics, as classified by the WHO AWaRe classification. A reduction in the LOS was observed, with a median of 16 days (8-34) during the post-implementation period compared to 27.5 days (10-56) during the pre-implementation period (p = 0.001). The median DOT increased during the post-implementation period to 8 (6-11), versus the increase to 7 (4-11) during the pre-implementation period (p ≤ 0.001). Finally, there was no significant difference observed in healthcare-associated CDI and infection-related readmission. This is a retrospective single-center, pre-post quasi-experimental study. Data including the documented pharmacist interventions were collected from the electronic medical record (EMR), the pre-implementation phase was in 2020, and post-implementation was in 2021. The primary outcome was to identify the number of AMS interventions through prospective audit and feedback review analysis. Secondary outcomes included antibiotic days of therapy (DOT), length of hospital stay (LOS), healthcare-associated Clostridioides difficile infection (CDI), and infection-related readmission. The pharmacist-driven weekend AMS is an opportunity for pharmacists to intervene and optimize patients' care plans. This initiative demonstrated significant increased AMS-related interventions, promoted judicious antimicrobial use, and contributed to a reduced length of hospital stay. Our findings need to be replicated in a larger prospective study.

Special audit examination of the coactiva courts of the central bank of Ecuador, period 2013 - 2014

Auditing is a fundamental tool in the management of entities, ensuring transparency and efficiency through adequate controls. This study analyzes the "Special Audit Review of the Coactiva Courts of the Central Bank of Ecuador" conducted by the Superintendency of Banks during the period 2013-2014. The objective is to evaluate the effectiveness of internal controls and administrative processes of the coactiva court. The results reveal significant deficiencies, including a lack of coordination between the areas of the Recovery and Liquidation Department, inconsistencies in the records of insolvency and bankruptcy judgments, and informal management of portfolio recovery. These deficiencies represent a high risk for the bank's operations, affecting approximately 70% of the processes reviewed. A set of practical recommendations are proposed, such as the implementation of an information filing and systematization system, the updating of the lawsuit registry and the creation of an annual operational audit plan. These measures are aligned with international best practices and seek to improve efficiency, effectiveness and transparency in the management of public resources.

Exploring user privacy awareness on GitHub: an empirical study

GitHub provides developers with a practical way to distribute source code and collaboratively work on common projects. To enhance account security and privacy, GitHub allows its users to manage access permissions, review audit logs, and enable two-factor authentication. However, despite the endless effort, the platform still faces various issues related to the privacy of its users. This paper presents an empirical study delving into the GitHub ecosystem. Our focus is on investigating the utilization of privacy settings on the platform and identifying various types of sensitive information disclosed by users. Leveraging a dataset comprising 6,132 developers, we report and analyze their activities by means of comments on pull requests. Our findings indicate an active engagement by users with the available privacy settings on GitHub. Notably, we observe the disclosure of different forms of private information within pull request comments. This observation has prompted our exploration into sensitivity detection using a large language model and BERT, to pave the way for a personalized privacy assistant. Our work provides insights into the utilization of existing privacy protection tools, such as privacy settings, along with their inherent limitations. Essentially, we aim to advance research in this field by providing both the motivation for creating such privacy protection tools and a proposed methodology for personalizing them.

Towards greener horizons: a comprehensive review of energy auditing in hybrid solar and wind systems

Towards greener horizons: a comprehensive review of energy auditing in hybrid solar and wind systems

Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility

Background and purposePeer review is an important component of quality assurance in radiotherapy. To our knowledge, there are no studies reporting on the feasibility and outcomes of the peer review process for magnetic resonance (MR) guided radiotherapy (MRgRT) on the MR linear accelerator (MR-Linac) despite the planning complexity involved and its evolving clinical indications. This study aimed to quantify the rate of change in treatment plans post-peer review and the time and resources required. Materials and methodsFifty-five cases presented at weekly MR-Linac peer review meetings across two centres from 8 June to 21September 2023 were prospectively collected. Cases were analysed to determine the rate and extent of plan changes based on the Peer Review Audit Tool for radiation oncology (PRAT) developed by the Royal Australian and New Zealand College of Radiologists (RANZCR). ResultsPeer review resulted in changes to 36.4 % of treatment plans (n = 20), with 3.6 % (n = 2) having major changes requiring deferment of treatment. The most frequent changes were to organs at risk (OAR) volumes involving both delineation and increased OAR sparing (16.4 %, n = 9), total dose and fractionation (10.9 %, n = 6) and target volume dose coverage (5.5 %, n = 3). Patients with SBRT plans (39.1 % cf 22.2 %), oligometastatic/oligoprogressive sites (38.1 % cf 30.7 %) and reirradiation cases (41.2 % cf 34.2 %) had higher rates of change. Cases took a mean of 7 min (range 2–15 minutes) to discuss. ConclusionThe high rates of plan changes support the value of peer review in MRgRT. We recommend, where possible that all MRgRT cases, particularly those involving SBRT plans, oligometastatic/oligoprogressive sites, and/or reirradiation, be subject to peer review.

Patch Infection Following Carotid Endarterectomy: A Single-Center Audit and Literature Review.

Carotid endarterectomy (CEA) is a surgical procedure that carries a rare but serious risk of patch infection. This study examines the management and outcomes of patch infections in CEA patients treated in our department over 23 years. A literature review of studies on prosthetic patch infection following CEA published from January 1992 up to December 31, 2022 was also carried out. We conducted a retrospective audit of patients who underwent CEA in a hospital in Athens, Greece, between January 1, 1999, and December 31, 2022. Between January 1999 and December 2022, we treated seven patients with carotid patch infections who had their original CEA at our department. Staphylococcus epidermidis and Staphylococcus aureus were the most common infecting organisms. One patient (14%) died from hemorrhagic shock before surgery, while the remaining six (86%) underwent debridement, patch excision, and great saphenous vein patching. No peri-operative deaths or strokes occurred, and there were no re-infections during a median follow-up of 159 months. Excision of infected material followed by revascularization using a vein graft remains the prevailing treatment.

Third-party vendor risks in IT security: A comprehensive audit review and mitigation strategies

Third-party vendor risks in IT security: A comprehensive audit review and mitigation strategies

CSP2023: 352 - A clinical audit of medication reviews completed by an Independent Physiotherapy Prescriber in a community spinal pain management service

CSP2023: 352 - A clinical audit of medication reviews completed by an Independent Physiotherapy Prescriber in a community spinal pain management service

Audit Review of GP Referrals to Perinatal Mental Health Team – Emphasis on Medication

Audit Review of GP Referrals to Perinatal Mental Health Team – Emphasis on Medication

Exploring The Impact of Digital Technology Transformation in Islamic Education: The Islamic Education Teachers Perspective

The empowerment of digital education is one of the government’s reforms to ensuring that Malaysia’s education system remains relevant. However, some teachers still do not recognise the significance of adopting digital technology, resulting in the rejection of a few Islamic education teachers. Thus, the purpose of this study is to investigate how Islamic education teachers perceive the impact of digital technology use in the classroom. Using a case study design and a qualitative research approach, the study included five Islamic education teachers who are proficient in digital technology and were chosen by a snowball sampling process. Interviews, in-person observations, and audio-visual analysis were used to gather data. Using NVIVO 14 software, the data was subjected to a thematic analysis. Credibility, transferability, and dependability are ensured for qualitative research data by triangulation, member check and peer review, rich and thick audit trail, and inter-rater. The study’s aims, which include improved productivity in the classroom; problem-solving efficacy; quick access to information; and more systematic data management, are addressed via four main themes and eight sub-themes. It is intended that this study will offer a viewpoint that encourages Islamic education teachers to make the most of digital technology in the classroom and in day-to-day operations.

Audit firm tenure and corporate tax avoidance: evidence spanning COVID-19 pandemic

Purpose This study aims to examine the effect of audit firm tenure (AFT) on corporate tax avoidance (CTA) and the moderating effect of the COVID-19 pandemic. Design/methodology/approach The sample comprises 41,074 firm-year observations from 32 countries from 2015 to 2020, for which data are collected from various sources: financial data from the Refinitiv database, country corporate tax rates from the Tax Foundation, and other country-level data from the World Bank database. The authors use the book tax difference to measure CTA and multiple proxies for AFT. Findings This study finds that a longer AFT is associated with higher CTA, confirming the notion that long AFT impairs auditor independence. The findings remain robust when considering various AFT proxies, incorporating Hofstede’s cultural factors, using weighted least-squares estimation and addressing endogeneity through propensity score matching. This study also finds a non-linear relationship between extended client and auditor relationships and CTA, supporting the mandatory audit firm rotation regulation and increasing investors’ caution regarding the consequences of extended client–auditor relationships on firm behaviour. Research limitations/implications This study offers new evidence on the effect of the COVID-19 pandemic on the link between AFT and CTA and documents a non-linear relationship between AFT, which has not been addressed in prior studies. Practical implications The findings of this study have several significant practical implications. First, governments and policymakers gain insights into the consequences of extended auditor–client relationships, hence calling for a review of auditing and taxation regulations. Second, the findings provide important insights into the issue of auditor independence, especially during long engagements and crises such as COVID-19. Finally, investors and tax authorities should be more cautious about the risks of aggressive tax avoidance during crisis periods. Originality/value To the best of the authors’ knowledge, this is the first study to use a global data set to investigate the effect of AFT on CTA during the COVID-19 pandemic.

Use of Risk Management to Support Business Sustainability in the Automotive Industry

Today’s companies operate in a dynamic, constantly evolving, and highly competitive environment. The globalization of markets has significantly changed the economy, where companies operate within increasingly complex supply chains. The ever-increasing expectations of customers and company stakeholders, as well as the need to incorporate a comprehensive approach to the life cycle of manufactured products in corporate strategies, expose companies to a whole range of risks. The research was based on the need of organizations operating in the (automotive) industry to manage the dynamics of the business environment. This was accomplished using an appropriate model that, through its universality, would help to ensure the effective risk management in a holistic approach, protecting their performance and meeting the needs of the relevant stakeholders. The main idea of the research was to create and implement a dynamic model of risk management in the environment of a production organization based on the use of available methods such as SWOT, PESTLE, brainstorming, affinity diagrams, risk matrix, SIPOC diagram, risk, and the results of questionnaire surveys. The research was conducted in two directions: (1) designing the structure of the dynamic risk management model for the strategic management process; and (2) verifying the effectiveness of the proposed model in specific cases and evaluating the technical and economic benefits. To support the dynamics of the model, three basic management tools have been proposed: process review, internal audit, and management review, enriched with features that support the concept of risk-based thinking.

Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

"Introduction: Postoperative complications are an integral aspect of the surgical audit, being a surrogate marker of surgical quality. Despite demonstrated efficacy in most specialties, there is scarce validation of current systems in plastic and reconstructive surgery, let alone a system unique to the specialty. This review aims to establish the efficacy of current systems in plastic and reconstructive surgery and formulate a classification unique to our specialty. Methods: A PUBMED literature search was performed in January 2023 encompassing all available literature. Search terms included ‘classification’, ‘grading’, ‘postoperative complications’ and ‘adverse events’. Further additions through bibliographic linkage generated a total of 363 articles. Results: Twenty-four papers were related to PRS. Sixteen used current systems to describe postoperative complications, whereas eight papers used a system designed uniquely for PRS. The downfall of conventional systems is the simplicity of return to the operating theatre, constituting a single grade in the Clavien-Dindo Classification. Return to theatre has a broad scope for heterogeneity in plastic and reconstructive surgery, particularly in reconstructive patients. A modification of the Clavien-Dindo Classification is proposed. Conclusion: There is limited efficacy of current classification systems for postoperative complications in plastic and reconstructive surgery nor a well-validated system unique to the specialty. A modified system with a detailed emphasis on return to the theatre will be of value to plastic and reconstructive surgery and ideally correlate with important outcomes. This will be validated in a retrospective review of the complication audit from the developing institution."

Coaching Today's auditors: What causes reviewers to adopt a more developmental approach?

Audit workpaper review is a quality control mechanism intended to detect preparer errors and professionally develop preparers. In this study, we experimentally investigate two factors that theory predicts affect the degree to which audit reviewers adopt a developmental approach: local versus international preparer office affiliation and likely versus unlikely preparer recurrence. We find that reviewers adopt a less developmental approach for international preparers but a more developmental approach for preparers likely to recur. The adoption of a more developmental approach not only results in more coaching via review comments but is associated with greater detection of seeded preparer errors. Taken together, our findings highlight the susceptibility of quality control efforts in the global audit environment and identify recurrence as a potential intervention.

A retrospective review of effectiveness of ERAS post-operative pain protocol in hip replacement surgeries under general anaesthesia at a tertiary orthopaedic hospital

: The concept of enhanced recovery after surgery (ERAS) was first introduced in 1997 by a group of European surgeons led by Henrik Kehlet. The ERAS concept was introduced to target the factors delaying post-operative recovery such as organ dysfunction, surgical stress and to improve the surgical outcomes and length of stay at the hospital. The primary aim of this approach is to reduce the body’s response to surgical stress by implementing a multidisciplinary, multitude of interventions in a coordinated clinical pathway. It was first implemented for colorectal surgeries to improve the post-surgical recovery rates by decreasing the post-operative ileus and thereby reducing the cost and length of hospital stay. Since the successful introduction of the program, ERAS has been used in several other specialties such as breast, urological, gynaecological, and musculoskeletal procedures. Off-late ERAS has become important in orthopaedic surgeries, particularly elective hip and knee arthroplasties. A retrospective review audit was conducted at tertiary Orthopaedic NHS Hospital to determine the effectiveness of ERAS post-operative pain protocol in patients who had primary hip arthroplasty under general anaesthesia. The qualitative and quantitative data included the length of stay at the hospital and default rates in the ERAS pain protocol. The length of stay at the hospital in ERAS compliant group was a mean of 3.95 days and in ERAS default group was 4.7 days, showing an increase of 16% in the total duration. The IV PCA group had 4.6 days of the average length of stay.: ERAS pathway advocates for using opioid-sparing multimodal analgesia to control pain, peripheral nerve blocks (single-shot/continuous), and local infiltration /peri-articular injections have become a better alternative to opioids in controlling the immediate post-surgical pain effectively. There is clear evidence to suggest that these techniques can improve patient outcomes and decrease the duration of stay.

Direct induction onto high-dose long-acting injectable buprenorphine: A case series.

This case series reports on five patients with opioid use disorder (OUD) who were commenced directly onto high-dose long-acting injectable buprenorphine (LAIB). A retrospective audit and manual review of the electronic medical record at cohealth Innerspace was conducted for patients who had been directly inducted onto high-dose LAIB. Five cases were identified on retrospective manual file review. All patients identified were males aged between 33 and 60 years old and were treated with either high-dose Buvidal Weekly and Monthly preparations. No immediate significant adverse effects were noticed and 4 out of 5 remain engaged with treatment. This case series shows it is possible to directly induct patients with OUD onto high-dose LAIB preparations without significant side effects or harm to the patient and could be considered a viable option in the treatment of patients with OUD.

Novice Auditors and Audits of Fair Values: Knowledge and Skill Requirements*

AbstractNovice auditors are increasingly being asked to perform tasks that were not expected of them in the past, including evaluation of fair values (FVs). This study contributes to the auditing literature by investigating novice auditors' competencies required for correct performance of FV auditing tasks, identifying weaknesses, and suggesting actions that could be taken by educators and practitioners to address those weaknesses. Using the audit of goodwill impairment under IFRS as the exemplar task for identifying FV auditing competencies, we create a normative process table for the task based on accounting and auditing standards and authoritative valuation literature. We analyze the verbal protocols of novice auditors while they perform the task and compare their processes to the normative table to understand weaknesses in their competencies. Our findings are of interest to auditing educators and audit firm personnel responsible for staff training programs, audit program development (e.g., checklists), supervision, and review.

Disclosure of tax‐related critical audit matters and tax‐related outcomes

AbstractGiven that tax‐related critical audit matters (tax CAMs) were prevalent among accelerated filers (18.5% of observations) during the initial year of CAM disclosures, we examine whether an auditor's disclosure of tax CAMs is associated with variation in tax‐related financial reporting quality, tax avoidance, and tax‐related earnings management. Finding an association between tax CAMs and one of these tax outcomes would indicate that the new auditor reporting standard has indirectly affected investors. Examining the first year of CAM disclosures, we do not find that tax CAMs are associated with broad proxies of tax‐related audit or financial reporting quality (e.g., restatements, internal control weaknesses, comment letters) or tax avoidance (e.g., effective tax rates or book‐to‐tax differences). We do find that tax CAMs are associated with a modest increase in tax accrual quality, an increase in the reserve for unrecognized tax benefits, and a reduction in the likelihood of tax‐related earnings management. However, we do not find these tax CAM effects persist into the second year of CAM reporting. Our evidence is consistent with tax CAM disclosures having a modest but short‐lived effect on companies' reporting of tax accounts. Our findings should inform the PCAOB as they conduct their post‐implementation review of the new audit reporting standard.

The impact of audit review and related accountability on auditor performance: Evidence from an emerging economy

The impact of audit review and related accountability on auditor performance: Evidence from an emerging economy

Repeat audit findings: How FEMA responds to feedback

Given climate change, expansive hardscapes and high housing density across the United States, and with the increasing frequency and ferociousness of natural disasters of all sorts, the damages and costs associated with human lives, land, and property will continue to grow. In this environment, state and local governments have heavy reliance on federal assistance to repair and rebuild communities following such crises, specifically via the Public Assistance (PA) grant program. The U.S. Federal Emergency Management Agency (FEMA) administers this grant through a process of application and approval managed by ten regional offices. Increased claims to FEMA have strained these regional offices leading to their failure to incorporate audit feedback and review policies for the purpose of continuous improvement. In these disastrous times, FEMA's operational improvement is vital to the continued support of communities across the nation. The Agency has objectives to promote effective recovery, streamline funding to reduce costs, and conduct the PA program efficiently to realize better return on investment.This research measures this problem by examining the U.S. Office of Inspector General's (OIG) audit findings of FEMA regional offices to see if and how these audits are being utilized and incorporated. Results show that over time, these offices are conducting the due diligence related to feedback; however, they are not incorporating details of audits in a meaningful way. Though total errors do not result in significant change in how FEMA apportions funding among regional offices over time, the type of error (either overspending or underspending) does influence such change. Therefore, consistent errors continue in financial response to disasters to which the Agency responds, indicating future FEMA decisions and OIG recommendations should require shifting the focus from repeat audit findings to financial prudence.