Audit Study Research Articles

Dual-energy CT iodine overlay improves efficiency of oral contrast leak assessment.

Evaluation for gastrointestinal leak is a frequent imaging indication, and dual-energy computed tomography (DECT) with oral or rectally administered contrast can be used to improve efficiency and diagnostic confidence. To assess the value of the DECT iodine overlay (IO) reconstruction as a stand-alone image set compared to routine CT in assessing oral or rectal contrast leak from the gastrointestinal system. A blinded, retrospective audit study was performed by three readers who each interpreted 50 studies performed for assessment of oral or rectal contrast leak that were acquired using DECT. Each reader independently assessed both the routine CT images and the images of the reconstructed IO for contrast leak in random order with a six-week "wash-out period" between readings. Clinical follow-up provided the reference standard. Readers recorded the presence/absence of a leak, diagnostic confidence, image quality score, and interpretation time for each image set. Pooled data for overall accuracy in identification of a leak increased from 0.81 (95% confidence interval [CI]=0.74-0.87) for routine CT to 0.91 (95% CI=0.85-0.95) with IO, and the area under the curve (AUC) was significantly higher for IO than routine CT (P = 0.015). Readers required significantly less time to interpret IO than routine CT (median improvement of 12.5 s per image using pooled data; P < 0.001) while maintaining diagnostic confidence and perceived image quality. Use of DECT IO reconstructions for identification of oral or rectal contrast leak requires less time to interpret than routine CT with improved accuracy and maintained diagnostic confidence and perceived image quality.

Research and scholarly methods: Audit studies

AbstractAudit study methodologies have been utilized in pharmacy field research to obtain greater understanding of potential gaps in real‐world care and assess the accessibility of medications, services, and providers. Many audit studies utilize a secret‐shopper approach in which auditors follow specific assessment protocols and the subjects being audited are unaware of the audit taking place. The benefit of utilizing this approach, as compared to surveys or interviews, is that researchers are able to collect real‐world measures with minimized social desirability and recall biases. There are multiple audit study approaches investigators must consider. Additionally, successful audit studies often rely upon congruence of multiple auditors, and it is therefore essential to develop a study protocol that includes detailed guidance documents, data collection tools, and rigorous training and fidelity assessments. Audit methodologies must be conducted with meticulous auditor training and oversight, especially when investigators seek to audit a large sample and rely on auditors who may be participating on an unpaid volunteer basis. The purpose of this review is to provide an orientation to audit study methodologies and to describe best practices for conducting a successful audit study.

The demand for interns

We describe the demand for interns in the U.S. using ads from an internship-specific website. We find that internships are more likely to be paid when more closely associated with a specific occupation, when the local labor market has lower unemployment, and when the local and federal minimum wage are the same. A résumé audit study with about 11,000 applications reveals that employers are more likely to respond positively when internship applicants have previous internship experience. Particularly for unpaid internships, employers are also less likely to respond to applicants with black-sounding names and when the applicant is more distant from the firm.

Bibliometric Analysis Research on Audit Nexus in Corporate Governance

Audit study on corporate governance and its influence on the corporate organisation is expanding exponentially. It has been undeniable after the 2007-2008 financial crisis and corporate scandals. This review provides an overview of the evolution of scholarly literature on the relationship between audit and corporate governance in peer-reviewed publications published between 2010 and 2020. The study has used a bibliometric technique to review 48 researched documents from the Scopus database. The review highlights document type, publication trend, journal types, influential authors, impactful papers, and keyword co-occurrence network through VOSviewer visualisation. In addition, the findings uncover new trends that have surfaced over the past few decades and suggest possible future lines of research. This study contributes to our understanding of audit in corporate governance studies by reviewing documents systematically using bibliometric techniques and VOSviewer analysis for the study period.

Transparency and reproducibility in the journal of contextual behavioral science: An audit study

Increasing openness, transparency, and reproducibility in contextual behavioral science (CBS) through incorporating CBS-consistent open science practices was identified as a key aim of the ACBS Research Task Force. However, little data exist on the prevalence of open science practices currently being used in CBS research. This study aimed to address this gap by auditing the prevalence of open science and reproducibility practices in studies published in the Journal of Contextual Behavioral Science across 1 year, prior to the journal's adoption of open science recommendations (July 2020–July 2021). Aims of the study were twofold: first, to characterize current use of open science and reproducibility practices in JCBS to serve as a point for future comparison; second, to compare the rate of open science and reproducibility practices in JCBS, the flagship journal for contextual behavioral science, against two recently published audits of top clinical psychology journals. Domains audited were use of pre-registration, practices to ensure adequate power, data availability statements, use of standard reporting guidelines, preprints, conflict of interest statements, and resource and code sharing. Results indicated that studies published in JCBS had low rates of pre-registration, data availability statements, preprint posting, and resource and code sharing. Use of mandated standardized reporting guidelines and conflict of interest disclosures, both required by JCBS at the time of the audit, reflected relative strengths. Power for correlational studies was superior to power for experimental studies; the latter reflected a relative weakness compared to other clinical psychology journals. Rates of practices required by JCBS were significantly higher than those not required. JCBS may consider strongly encouraging or mandating other open science practices to incentivize researchers to use them.

Early Detection of Cancer using Machine Learning (ML) Techniques

Early detection of cancer sickness leads to rapid treatment, reducing the risk of morbidity and mortality. The diagnosis of oral cancer continues to be a challenge for dental careers, particularly in the location, evaluation, and review of early-stage oral disease. Due to the lack of optimal analysis using conventional methods, oral cancer is identified and grouped using AI at an early stage. AI techniques are used to show the movement and treatment of dangerous locations and may accurately predict future disease effects. AI techniques are used to show the movement and treatment of dangerous locations and may accurately predict future disease effects. A combination of expert AI and highlight determination calculations produces improved results in the early detection and forecast of oral cancer. The main goal and commitment of this audit study is to summarize the use of AI technologies for accurate early prediction of oral malignant development.

Pushing the Boundaries of Pedicled Chest Wall Perforator Flaps in Oncoplastic Breast Surgery.

Among 145 chest wall perforator flaps (CWPFs) performed at City Hospital, Birmingham (September 2017-February 2022), 11 were for novel indications, four were for whole breast reconstructions, two were for implant salvage procedures, three were CWPFs with skin paddle to replace excised skin/nipple-areola complex, andtwo werefor upper inner quadranttumours. Tumourcharacteristics and post-operative complications were noted. Patient-reported outcomes measures (PROMs) were measured using a questionnaire adapted from the National Mastectomy and Breast Reconstruction Audit (NMBRA) study. Among 11 patients, nine (81.81%) did not develop any complications.Ten patients responded to PROMs (median follow-up of eight months).The PROMs assessment showed that all patients (100%) were satisfied with the post-operative breast appearance. Of the patients,90% (9/10) felt the results of their surgery to be good, very good, or excellent. Of the patients, 70% (7/10) said that they have no/little persistent pain. None of the patients had difficulty carrying out normal activities. Thus, the applications of CWPFs could be extended for whole breast reconstruction, implant salvage procedures, where skin paddle is needed, and for upper inner quadrant tumours.

AUDITORIA ENERGÉTICA COM ÊNFASE EM ILUMINAÇÃO E CONDICIONAMENTO AMBIENTAL PARA UNIDADE ACADÊMICA I DE UM INSTITUTO FEDERAL

Population growth imposes on society a pattern of intense consumption that generates a need for greater awareness and energy management. In order to bring improvements and manage resources in an intelligent and efficient way, this article will present a practical study of an energy audit in a public building located on the IFPB campus João Pessoa-PB with the intention of seeking viable solutions to reduce energy consumption. The approach adopted for waste analysis consists of a careful survey of data from all areas of the building, listing consumption items such as lighting, air conditioning, as well as various equipment. Then, technical calculations were made to improve environments and implement new equipment, as well as calculate the payback to inform how long the return on investment would be. Finally, it was found that the proposed changes to the studied system would bring a return in the short term and with a long period of profitability.

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries.

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Medicaid coverage and access to obstetrics and gynecology subspecialists: findings from a national mystery caller study in the United States

Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial). This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance. Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility. From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, ±18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times. Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.

Inferring incompetence from employment status: An audit-like experiment.

Audit studies demonstrate that unemployed people are less likely to receive a callback when they apply for a job than employed candidates, the reason for this is unclear. Across two experiments (N = 461), we examine whether the perceived competence of unemployed candidates accounts for this disparity. In both studies, participants assessed one of two equivalent curriculum vitae's, differing only on the current employment status. We find that unemployed applicants are less likely to be offered an interview or hired. The relationship between the employment status of the applicant and these employment-related outcomes is mediated by the perceived competence of the applicant. We conducted a mini meta-analysis, finding that the effect size for the difference in employment outcomes was d = .274 and d = .307 respectively, while the estimated indirect effect was -.151[-.241, -.062]. These results offer a mechanism for the differential outcomes of job candidates by employment status.

Distinctively Black Names and Educational Outcomes

Names can convey information about race or ethnicity and therefore can be used to discriminate against protected groups; many researchers have demonstrated as much through audit studies. Yet few studies link life outcomes with names using observational data. We use administrative data from over 3 million Black students to ask whether those with more statistically Black names have differential educational outcomes. We find that while test scores, college enrollment, and college completion are negatively correlated with Black names net of background characteristics, this relationship is absent when we compare across siblings within households.

Not in My Schoolyard: Disability Discrimination in Educational Access

Disabled people constitute the largest minority group in the United States, and disability discrimination is prohibited under federal law. Nevertheless, disability has received limited attention in the sociology of discrimination. We examine disability discrimination in an important gatekeeping interaction: access to public education. In an audit study of more than 20,000 public schools, we sent emails to principals from fictitious prospective parents asking for a school tour, varying the child’s disability status and gender and the parent’s race. Principals were significantly less likely to respond when the child had a disability, especially when the email came from a Black (rather than White) parent. A survey experiment with 578 principals revealed possible mechanisms. Principals viewed disabled students as more likely to impose a significant burden on schools, but disabled Black students faced an additional disadvantage due to stereotypes of their parents, who were perceived to be less valuable future members of the school community in terms of fundraising, volunteering, and other forms of engagement to support the school. Our results highlight that discrimination against people with disabilities begins long before the labor market and illuminate how the intersection between disability and race shapes inequalities in educational access.

Analysis of Religious Bias among Christian Students in Science

AbstractChristians are notably underrepresented in science in part due to long‐standing public perceptions of science‐religion incompatibility and antireligious bias in science. This research explores whether undergraduates at a Christian university perceive and impose anti‐Christian cultural stigma in science. Survey results from 126 biology students revealed that though students generally perceived the culture of science to be anti‐Christian, they perceived Christians to have equal opportunities for scientific achievement. Results from a quasi‐experimental audit study, in which students evaluated one of two profiles for mock prospective Ph.D. applicants (Christian or undisclosed faith) showed that students did not project anti‐Christian stereotypes in terms of competence, hireability, or likeability, but showed some evidence of pro‐Christian favorability. Together, this study suggests that the affirmational community of a Christian University may alleviate some negative impacts of anti‐Christian stereotypes in academic biology, even as students perceive discrimination against Christians in science and atheists as more scientifically competent.

Remote EPID-based dosimetric auditing using DVH patient dose analysis

Objective. The aim of this work was to develop and validate a method for remote dosimetric auditing that enables dose-volume histogram parameter comparisons of measured and planned dose in the patient CT volume. Approach. The method is derived by adapting and combining a remote electronic portal imaging (EPID) based auditing method (Virtual Epid based Standard Phantom Audit—VESPA) and a method to estimate 3D in-patient dose distributions from planar dosimetric measurements. The method was tested with a series of error-induced plans including monitor unit and multileaf collimator (MLC) positioning errors. A pilot audit study was conducted with eleven radiotherapy centres. IMRT plans from two clinical trials, a post-prostatectomy (RAVES trial) plan and a head and neck (HPV trial) plan were utilized. Clinically relevant DVH parameters for the planned dose and estimated measured dose were compared. Main results. The method was found to reproduce the induced dose errors within 0.5% and was sensitive to MLC positioning errors as small as 0.5 mm. For the RAVES plan audit all DVH results except one were within 3% and for the HPV plan audit all DVH results were within 3% except three with a maximum difference of 3.2%. Significance. The results from the audit method produce clinically meaningful DVH metrics for the audited plan and could enable an improved understanding of a centre’s radiotherapy quality.

Implementation of point-of-care INR testing to improve effectiveness of anticoagulation clinic

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Oral Vitamin K antagonist (VKA) is still widely used for anticoagulation. Anticoagulation clinics are set up to monitor patients’ INR and adjust their VKA doses accordingly. Anticoagulation clinic in our centre introduced point-of-care (POC) INR testing in June 2021 to improve the effectiveness of the clinic. Purpose This audit was done to evaluate the effectiveness of anticoagulation since the introduction of the POC INR test into the clinic workflow. Methods This was a retrospective, cross-sectional, cohort audit study. The study period was from 1st June 2021 to 31st July 2022. List of patients who attended the clinic from 1st – 31st January 2022 was taken from the clinic log and their electronic medical records were reviewed for the study period. Only patients who have been established on VKA for at least 3 months were included in the audit. The data collected included their basic demographics, indication for VKA, any complications / death during the study period and if their VKA had been stopped and why and serial INRs from the POC INR test during the study period. The time in therapeutic range (TTR) is calculated by Rosendaal method and all the results analysed on Microsoft Excel. The audit standard for safe and effective anticoagulation was a TTR ≥ 70%. Results were compared to an audit done previously for the centre’s anticoagulation clinic done in 2020. Results 207 patients were included in this audit. Male patients accounted for 53.6% of the study population. Their ages ranged from 22 years to 102 years with a median age of 67 years. Majority of the patients were on VKA as stroke prevention for their atrial fibrillation (AF) (79.7%), followed by metallic valve replacement (13%). The median TTR for patients with AF had improved from 40.8% in 2020 to 51.05% in 2020-21 study period and this difference is significant (p = 0.017). Patients getting effective anticoagulation also improved from 23.26% in 2020 to 26.79% during this audit period. 13% of the study population developed complications on VKA in which 2.9% of patients developed gastrointestinal bleed and 1% developed intracranial haemorrhage. There were 4 fatalities, none were from gastrointestinal bleeding, intracranial haemorrhage or stroke. 10% of patients had their VKA changed to a novel oral anticoagulant (NOAC) as they were identified to have poor TTR during clinic review. Conclusions The introduction of POC INR test has proven to make significant improvement in patient’s median TTR for patients with AF. However, more efforts need to be made to further improve effectiveness of anticoagulation in our patients such as converting them to a NOAC if eligible or more thorough counselling and more frequent INR checks.

Silenced on social media: the gatekeeping functions of shadowbans in the American Twitterverse

AbstractAlgorithms play a critical role in steering online attention on social media. Many have alleged that algorithms can perpetuate bias. This study audited shadowbanning, where a user or their content is temporarily hidden on Twitter. We repeatedly tested whether a stratified random sample of American Twitter accounts (n ≈ 25,000) had been subject to various forms of shadowbans. We then identified the type of user and tweet characteristics that predict a shadowban. In general, shadowbans are rare. We found that accounts with bot-like behavior were more likely to face shadowbans, while verified accounts were less likely to be shadowbanned. The replies by Twitter accounts that posted offensive tweets and tweets about politics (from both the left and the right) were more likely to be downtiered. The findings have implications for algorithmic accountability and the design of future audit studies of social media platforms.

How suitable are clinical vignettes for the evaluation of symptom checker apps? A test theoretical perspective.

To evaluate the ability of case vignettes to assess the performance of symptom checker applications and to suggest refinements to the methodology used in case vignette-based audit studies. We re-analyzed the publicly available data of two prominent case vignette-based symptom checker audit studies by calculating common metrics of test theory. Furthermore, we developed a new metric, the Capability Comparison Score (CCS), which compares symptom checker capability while controlling for the difficulty of the set of cases each symptom checker evaluated. We then scrutinized whether applying test theory and the CCS altered the performance ranking of the investigated symptom checkers. In both studies, most symptom checkers changed their rank order when adjusting the triage capability for item difficulty (ID) with the CCS. The previously reported triage accuracies commonly overestimated the capability of symptom checkers because they did not account for the fact that symptom checkers tend to selectively appraise easier cases (i.e., with high ID values). Also, many case vignettes in both studies showed insufficient (very low and even negative) values of item-total correlation (ITC), suggesting that individual items or the composition of item sets are of low quality. A test-theoretic perspective helps identify previously undetected threats to the validity of case vignette-based symptom checker assessments and provides guidance and specific metrics to improve the quality of case vignettes, in particular by controlling for the difficulty of the vignettes an app was (not) able to evaluate correctly. Such measures might prove more meaningful than accuracy alone for the competitive assessment of symptom checkers. Our approach helps elaborate and standardize the methodology used for appraising symptom checker capability, which, ultimately, may yield more reliable results.

Do Women Receive Worse Financial Advice? An Audit Study in Hong Kong, China

Do Women Receive Worse Financial Advice? An Audit Study in Hong Kong, China

A cross-sectional study of prescription audit in outpatient departments of tertiary care hospital

Background: Prescriptions are medico-legal documents, and it is the duty of every physician to write a complete, legible, and valid prescription to ensure rational drug use and prevent the occurrence of medication errors. A periodic prescription audit is required for the identification of common deficiencies in the prescriptions and to undertake corrective measures for improving the prescribing practices. This is a quality improvement process that seeks to improve patient care. It supports health professionals in making sure their patients receive the best possible care. Aims and Objectives: To find out the common areas of noncompliance in prescriptions by using the prescription audit tool by the National Health Mission. Materials and Methods: A cross-sectional study of prescription audits was conducted using the prescription audit tool by the National Health Mission. Prescriptions were randomly taken from various clinical outpatient departments according to the percentage they contribute to the outpatient population. This tool contains both indicators to check the completeness of the prescription and indicators for the legibility and rationality of the prescription. 235 prescriptions were audited, and the parameters that scored low were identified. Results: The lowest score was seen with parameters like mentioning allergy status (4.89%), duly signing prescriptions (44%), recording follow-up advice and precautions (19%), and mentioning the review date (16.8%). Parameters that need improvement are recording the brief history and salient features of the clinical examination, to write the presumptive diagnosis. Conclusion: Conducting prescription audits frequently in all hospitals help in better understanding the prescribing behavior of the physicians, and followed by constant communication and training of the physicians, this is the most effective way to improve prescription practice within the hospital.