Audit Protocol Research Articles

PRACTICE OF GOWNING AND GLOVING TECHNIQUE AMONG HEALTH PERSONNEL AT OPERATION THEATRE OF TEACHING HOSPITAL, BHARATPUR

Background: Gowning and gloving is regarded as the basic component of modern Surgery, its standard of practice is directly concerned with patient safety and infection prevention. The aim of this study was to observe the practice of gowning and gloving technique among health personnel at operation theatre of teaching hospital, Bharatpur, Nepal. Methods: A descriptive cross-sectional study was carried out among 90 health personnel who had scrubbed in the operation theatre before approached to sterile field, by using observational checklist. Sample was selected by using non probability, consecutive sampling technique. Data were analyzed using descriptive and inferential statistics to find the association between the variable. Results: The findings highlighted, that only 36.7% of the health personnel fulfill the criteria of surgical gowning and gloving. The main issues found in the study were not picking up the entire folded gown through all layers from the wrapper (31.1%), and not holding the gown near the gown’s neck and touch unsterile objects (18.9%). Conclusions: The level of practice on gowning and gloving technique was statistically significant with professional experience and education of the respondents. Hence, operation theatre department should develop the audit protocol and in-service training model for the surgical team.

Improved Cloud Auditing Protocol and Its Application for Pandemic Data Management

Data integrity verification mechanisms play an important role in cloud environments. Recently, a lightweight identity-based cloud storage audit scheme has been proposed; this paper points out security vulnerabilities of their OffTagGen algorithm. That is, the attackers such as malicious cloud servers can forge the tags, which can destroy data integrity. By improving the construction of OffTagGen algorithm, an improved security cloud auditing protocol is proposed in this work to better protect user’s privacy. The analysis shows that the new protocol is effective and resistant to attacks.

Identity-based remote data checking with a designated verifier

Traditional remote data possession auditing mechanisms are usually divided into two types: private auditing and public auditing. Informally, private auditing only allows the original data owner to check the integrity of its outsourced data, whereas anyone is allowed to perform the checking task in public auditing. However, in many practical applications, the data owner expects some designated verifier (instead of others) to audit its data file, which cannot be covered by the existing private or public auditing protocols. Thus, in a recent work, Yan et al. proposed a new auditing technique with a designated verifier [IEEE Systems Journal, 12(4): 1788-1797, 2020]. Nevertheless, we note that this protocol suffers from complicated management of certificates and hence heavily relies on public key infrastructure. To overcome this shortcoming, in this paper, we propose an identity-based auditing protocol with a designated verifier, which not only avoids the introduction of certificates, but also has the desired property of only allowing specific verifier to audit. Its security is based on the classical computational Diffie-Hellman and Weil Diffie-Hellman assumptions. Finally, performance analysis shows that our proposed protocol is very efficient and suitable for some real-life applications.

Blockchain Assisted Multi-Copy Provable Data Possession With Faults Localization in Multi-Cloud Storage

Cloud storage service provides a convenient way for users to store massive data. To guarantee the integrity of the outsourced data, provable data possession (PDP) schemes for multi-copy data and multi-cloud have been proposed respectively. To avoid a single point of failure and to increase the security of the outsourced data, many users store multiple copies on multiple cloud servers. However, few protocols support multi-copy data and multi-cloud at the same time. Considering that three entities (third-party auditor, cloud organizer and cloud storage servers) participate in the auditing process, it is difficult for users to locate the position of the faults, including entity position, file position and data block corruption position, when the auditor reports data corruption. In this paper we propose a certificateless multi-copy public auditing protocol in multi-cloud storage, which supports to locate the faults entities and corrupted data blocks. Specifically, instead of relying on a trusted centralized judgement entity to deal with the faults detection, smart contracts combined with the binary search technique are utilized to help achieve the reliability of faults localization result and the accuracy of the judgement. Additionally, the proposed protocol supports data dynamics update, including data modification, insertion and deletion. Theoretical analysis and experiment results show that our protocol is efficient and practical.

Критерії та індикатори якості стоматологічної допомоги: стан розробки та використання

Healthcare quality criteria and indicators allow the head of the health care facility to clearly orientate in the degree of achievement of targets and improvement of results for patients. Studies of approaches to the formation of criteria and indicators of quality in the conditions of real domestic clinical practice, in particular, dental, are isolated. At the same time, in Ukraine there are no clinical protocols of dental care based on evidence-based technologies, which contain clinical quality indicators. The purpose of the study was to conduct a research on approaches to the development and usage of criteria and indicators for the quality of dental care in dental health facilities. Materials and methods. Such materials were used in the study as work plans for 2010-2019, administrative documents (orders), maps of expert assessments, "Guidelines for quality", internal audit protocols (a total of 149 units) of the three regional health care institutions of the dental profile. Methods, which were used, are system and process approach, content analysis, comparative analysis, graphical method. Results and discussion. In each institution, criteria and quality indicators are developed and monitored at the level of the doctor, line managers, the head of the institution and the medical council. Line managers conduct expert quality assessment, generalized "models of end results" which are formed at the level of the head of the institution. Detailed sets of criteria for the quality of the dental care process, ancillary processes and quality management systems are formed. Quantitative evaluation of the corresponding results on a scale and individual percentages is carried out. In general, the set of quality criteria and indicators is excessive in number, which does not meet the quality criteria defined by the standards for quality management systems, it contains mainly indicators of traditional industry reporting. At the same time, the world's evidence-based technologies of dental practice contain clinical indicators that reflect the use of interventions that have a proven impact on the quality of dental care expected by the patient, and which ensure efficient use of resources. Conclusion. The introduction of evidence-based technologies in dental practice is appropriate to improve approaches to the development of quality criteria and indicators, monitoring of clinical processes and compliance audits should be used, expert assessment should be carried out in case of defects

Reduction of Energy Intensity in Broiler Facilities: Methodology and Strategies.

Broiler facilities consume a lot of energy resulting in natural source depletion and greater greenhouse gas emissions. A way to assess the energy performance of a broiler facility is through an energy audit. In the present paper, an energy protocol for an energy audit is presented covering both phases of data collection and data elaboration. The operational rating phase is analytically and extendedly described while a complete mathematical model is proposed for the asset rating phase. The developed energy audit procedure was applied to poultry chambers located in lowland and mountainous areas of Epirus Greece for chambers of various sizes and technology levels. The energy intensity indices varied from 46 to 89 kWh/m2 of chamber area 0.25–0.48 kWh/kg of produced meat or 0.36–1.3 kWh/bird depending on the chamber technology level (insulation, automation, etc.) and the location where the unit was installed. The biggest energy consumer was heating followed by energy consumption for ventilation and cooling. An advanced technology level can improve energy performance by ~ 27%−31%. Proper insulation (4–7 cm) can offer a reduction of thermal energy consumption between 10 and 35%. In adequately insulated chambers, the basic heat losses are due to ventilation. Further energy savings can be achieved with more precise ventilation control. Automation can offer additional electrical energy saving for cooling and ventilation (15–20%). Energy-efficient lights can offer energy saving up to 5%. The use of photovoltaic (PV) technology is suggested mainly in areas where net-metering holds. The use of wind turbines is feasible only when adequate wind potential is available. Solar thermal energy is recommended in combination with a heat pump if the unit's heating and cooling systems use hot/cold water or air. Finally, the local production of biogas with anaerobic fermentation for producing thermal or electrical energy, or cogenerating both, is a choice that should be studied individually for each farm.

A prospective clinical audit on quality of anaesthesia and accidental awareness in patients undergoing elective surgery under general anaesthesia

Background: In order to assess and improve quality of patient care in perioperative period, knowledge of patient perspective is most important. A Prospective Clinical Audit was done on Quality of Anaesthesia and Accidental Awareness in patients undergoing elective surgery under General Anaesthesia. Aims a) The primary aim is to assess the quality of peri-operative anaesthesia care and patient satisfaction using a validated patient reported outcome measure. b) To establish an estimate of accidental awareness during general anaesthesia. Settings and Designs: This was a cross-sectional, prospective audit on elective post-operative patients who underwent surgery under routine balanced general anaesthesia at a tertiary health care centre. Total 94 post-operative cases, who underwent surgery within last three months, were included in the audit. Material and Methods: Audit protocol was presented to competent Institutional Ethics committee and approval taken. The patients included in the audit had received routine balanced general anaesthesia for their surgery along with prophylactic analgesic, antiemetic and antacid intra-operatively. Anaesthetists randomly visited to the patients 24 hours after surgery and distributed structured questionnaires to the participants. Basic demographic information was collected from medical record and patients. We used Bauer Patient Satisfaction Questionnaires to obtain data regarding anaesthesia related discomfort and Modified Brice Questionnaire was used to assess Accidental Awareness during Anaesthesia. Statistical Analysis: SPSS software for Windows version 21.0 was used for data analysis. Categorical data was presented as frequency and proportion whereas continuous data was presented as mean and Standard Deviation. Results: Mean age of study subjects was- 51.81(16.82). Most of the cases belonged to ASA Grade III&IV (82.9%). When evaluating the questions on anaesthesia-related discomfort, the most frequent complaint of

LDuAP: lightweight dual auditing protocol to verify data integrity in cloud storage servers

LDuAP: lightweight dual auditing protocol to verify data integrity in cloud storage servers

A provably secure and public auditing protocol based on the bell triangle for cloud data

With the rapid development of cloud computing, cloud storage has been accepted as a convenient service by an increasing number of organizations and individuals. However, when users lose control of their data, ensuring that the uploaded data are securely stored by the cloud becomes a critical requirement. A key research challenge associated with existing designs of data auditing protocols is the limitation of application scenarios due to low auditing efficiency. In order to address this problem, we propose a provably secure and public auditing protocol based on Bell triangle for cloud data with blockless verification and batch auditing. We introduce the associative property of Bell triangle; design an index conversion algorithm to convert the one-dimensional index to a two-dimensional index ensuring that the block signature satisfies the Bell triangle requirements, and develop a recursive association algorithm to ensure relevance between the signatures of adjacent file blocks. This protocol offers significant advantages over existing protocols in terms of auditing efficiency and security in a multi-user and high-volume environment. In addition, the security analysis and the results of the experiment indicate that the protocol is secure and efficient.

Enhanced recovery protocols in patients undergoing pancreatic surgery: An umbrella review.

AimTo identify, synthesize and appraise the systematic reviews of ERAS for patients undergoing pancreatic surgery and facilitate ERAS implementation.DesignAn umbrella review was used to identify systematic reviews.MethodsA systematic search following the PRISMA guidelines was used to search databases including PubMed, Embase, Cochrane Library, CINAHL, CNKI, WanFang and VJIP. AMSTAR 2 was used to appraise the quality of included reviews.ResultsTen systematic reviews were included. The quality of all included systematic reviews was rated as “critically low.” The most frequently reported ERAS elements were epidurals analgesia/PCA (9/10), goal‐directed mobilization (9/10) and early removal of drains (9/10). Only one review mentioned audit protocol compliance. None of the included reviews reported discharge standards. Ten reviews reported decreased length of stay, seven reviews reported lower hospital costs, and six reviews reported decreased total complications rate. There were no adverse effects reported.

Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction.

To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. Patients known to a regional UK cleft center. Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality (P < .001), hyponasality (P < .05), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality (P < .001), nasal emission (P < .01), and passive cleft speech characteristics (P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality (P < .01) in this group. Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.

PMAB: A Public Mutual Audit Blockchain for Outsourced Data in Cloud Storage

With the rapid growth of data, limited by the storage capacity, more and more IoT applications choose to outsource data to Cloud Service Providers (CSPs). But, in such scenarios, outsourced data in cloud storage can be easily corrupted and difficult to be found in time, which brings about potential security issues. Thus, Provable Data Possession (PDP) protocol has been extensively researched due to its capability of supporting efficient audit for outsourced data in cloud. However, most PDP schemes require the Third-Party Auditor (TPA) to audit data for Data Owners (DOs), which requires the TPA to be trustworthy and fair. To eliminate the TPA, we present a Public Mutual Audit Blockchain (PMAB) for outsourced data in cloud storage. We first propose an audit chain architecture based on Ouroboros and an incentive mechanism based on credit to allow CSPs to audit each other mutually with anticollusion (any CSP is not willing to help other CSPs conceal data problems). Then, we design an audit protocol to achieve public audit efficiently with low cost of audit verification. Rigorous analysis explains the security of PMAB using game theory, and performance analysis shows the efficiency of PMAB using the real-world dataset.

A perceptual outcome measure of velopharyngeal function based on the Cleft Audit Protocol for Speech-Augmented (CAPS-A VPC-Sum): Validation through a speech osteotomy study.

The status of the velopharyngeal mechanism can be inferred from perceptual ratings of specified speech parameters. Several studies have proposed the measure of an overall velopharyngeal composite score based on these perceptual ratings and have reported good validity. The Cleft Audit Protocol for Speech-Augmented (CAPS-A) is a validated and reliable perceptual framework for the assessment of cleft speech and velopharyngeal function used by all Regional Cleft Services in the UK and Ireland. An overall velopharyngeal composite summary score based on the CAPS-A would serve as an important surgical outcome measure of speech. To develop and validate a velopharyngeal composite summary score based on perceptual ratings made on the CAPS-A (CAPS-A VPC-Sum) using data from a maxillary osteotomy (MO) study. There were two surgical groups: a cleft lip and palate (CLP) (N = 20) group and a non-CLP group (N = 10), and a normal control group (N = 20). Participants in groups 1 and 2 were seen for perceptual and instrumental assessments of speech and velopharyngeal function preoperatively (T1), 3 months (T2) and 12 months (T3) postoperatively. Perceptual speech data were collected and rated by independent listeners using CAPS-A. Moderate to strong interrater reliability for perceptual data (rs = 0.503-1.000, all p < 0.01) and strong to very strong reliability for videofluoroscopic measurements (rs = 0.746-0.947) were found. Construct validity of the CAPS-A VPC-Sum was shown by an increase in postoperative scores for the CLP group only ϰ2 (2) = 9.769, p = 0.008 and significant differences between the CLP and the other two groups at T2 and T3 using independent t-tests. Convergent and divergent validity was indicated by a positive moderate correlation with related parameters (e.g., hypernasality rs = 0.869, p < 0.01) and a weak correlation with unrelated parameters (e.g., amount of forward advancement rs = 0.160, p = 0.526). Criterion validity was found by a moderate correlation between closure ratio rs = -0.541, p = 0.020 and CAPS-A VPC-Sum. A velopharyngeal composite score based on perceptually rated parameters serves as an important surgical speech outcome measure. The CAPS-A VPC-Sum is a useful, reliable and valid outcome measure of velopharyngeal function. There are added positive implications for other clinicians using geographically and language-specific adapted versions of the CAPS-A internationally. What is already known on this subject Velopharyngeal composite scores based on perceptually rated speech parameters have been shown to have both clinical and research utility, serving as a useful surgical outcome measure. However, such a composite score must be specifically validated on the perceptual speech framework upon which it is based, as there are differences in measurement methods and terminology across cleft speech perceptual frameworks internationally. What this paper adds to existing knowledge The CAPS-A is a nationally used tool in the UK and Ireland for audit and research purposes with validated and adapted international versions. This paper reports on the validation of the derived velopharyngeal composite score measure based on the CAPS-A and an English-speaking sample, providing evidence of its validity through a speech osteotomy study. What are the potential or actual clinical implications of this work? This work provides CLP teams who use CAPS-A with a validated surgical speech outcome measure of velopharyngeal function. It has positive implications also for adapted versions of the CAPS-A internationally.

Audit Outsourced Data in Internet of Things

With the increase in network transmission rates, the Internet of Things (IoT) has gradually become a trend. Users can upload the data generated by the device to the cloud database to save local storage space, thereby reducing local storage costs. Because uploading data to the cloud loses physical control of the data, an audit is required. Traditional audit protocols are not completely suitable for lightweight devices in the IoT. This paper proposes a new type of audit protocol suitable for lightweight devices with weak computing power. This protocol transfers part of the computation of data tags to a cloud storage provider (CSP) with strong computing power, thereby reducing the introduction of computing entities. Our scheme supports the dynamic operation of data and guarantees the effectiveness of challenge response by blockchain. Compared with existing schemes, our scheme is more secure and effective.

83 Closed Loop Audit Examining Documentation of Advanced Trauma and Life Support (ATLS) Secondary Survey in Polytrauma Cases at The Royal Infirmary of Edinburgh (RIE)

Abstract Introduction Secondary survey is a key aspect of the ATLS guidelines in avoiding missed injuries in polytrauma patients. Aim: Evaluate the documentation of secondary survey in polytrauma cases admitted to the RIE A+E department. Method Standard audit protocol, retrospective data collection. Polytrauma patients and patients requiring Trauma CT were identified from the local trauma database. Primary outcome was successful completion and documentation of secondary survey. Cycle 1: All patients from 01/01/2015-01/09/2015. Local policy change included an A+E trauma booklet and policy of secondary survey on admission to Intensive Care. Cycle 2 was completed post-intervention for patients presenting between 11/01/2019-29/05/2019. Results Cycle 1 (N = 20, N Secondary survey documented=10, mean=50%). Mean time to secondary survey was 8 hours (range 3-49). Cycle 2 (N = 28, N Secondary survey documented=24, mean=87.5%). Mean time to a secondary survey was 4 hours 30 minutes (range=1-21hrs). Significant improvement in documentation (Fisher’s Exact Test, P = 0.017). Conclusions Implementation of the secondary survey protocol and trauma booklet significantly improved documentation of secondary survey in the polytrauma patient. Evidence also suggests improved time to secondary survey. However, documentation of secondary survey is not universal indicating further improvement is required in trauma care, as the RIE moves towards becoming a National Major Trauma Centre.

989 Improving the Completion of Hospital Anticipatory Care Plans in Orthopaedic Trauma Wards During The COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has highlighted the importance of the Hospital Anticipatory Care Plan (HACP). New guidance recommends all patients admitted acutely to hospital should have a HACP completed within 24 hours. We aimed to assess how many orthopaedic trauma patients admitted to the study centre had HACP completed within 24 hours of admission.MethodDepartmental Quality Improvement Project (QIP) permission was granted, and standard audit protocol was utilised. Data were collected in a retrospective manner using our trauma database and online patient record system. Educational interventions including staff teaching sessions and dissemination of infographic posters were implemented. Cycle two was repeated in similar fashion.ResultsCycle one (50 patients): 37/50(74%) had HACPs completed. Of those with HACPs, 18/37(49%) were completed within 24 hours. Median time to completion was 45.3 hours (range 0.4-275.1 hours). Cycle two (58 patients): HACP completion significantly improved (56/58, 97%; p < 0.01), with more completed within 24 hours (50/56, 89%; p < 0.01). The median time to completion was decreased to 4.92 hours (range 0.27-60.6; p < 0.01).ConclusionsUnit compliance was initially poor however significantly improved with educational measures. Failing to identify ceilings of care early can result in difficult decisions having to be made in critical situations, risking suboptimal patient care.

66 Cycle 1: Time for Peripherally Inserted Central Catheter (PICC) Insertion for Patients with Complex Infections in The Trauma and Orthopaedic Department at The Royal Infirmary of Edinburgh (RIE)

Abstract Introduction Bone, joint and soft tissue infections often require long term antibiotic therapy alongside operative management. Intravenous (IV) access is essential for antibiotic administration and monitoring. ‘Long-lines’ such as PICC provide reliable long-term IV access. Aim: analyse time to insertion of ‘Long-lines’ and effects on patient outcomes. Method Standard audit protocol. Data tool was developed, trialled, and tested. Data was collected retrospectively from departmental database and TRAK (Online patient record system) for patients admitted with suspected bone, joint or soft tissues infection from 01/11/19- 29/2/20. Results 91 patients admitted with presumed infection. PICC requested in 30 patients. Mean time to PICC request from admission was 8.7 days (1-33). 23 patients received PICC. Mean time to PICC following request was 6.7 days (1-15). Mean time to PICC from admission was 15.9 days (4-39). 10 of 30(33.3%) patients had documented missed antibiotics due to lack of IV access. Conclusions Large variation in time for patients receiving PICC from admission and from time of request. A significant proportion of patients are missing IV antibiotics due to poor IV access. Improvement in time to ‘longlines’ would reduce incidence of venepuncture in patients requiring IV access in addition to reducing missed IV antibiotics due to lack of access.

O82: SCORPION: SCOPING OUTCOMES FOR ACUTE PANCREATITIS: A NATIONWIDE STUDY

O82: SCORPION: SCOPING OUTCOMES FOR ACUTE PANCREATITIS: A NATIONWIDE STUDY

The Relationship Between Maxillary Growth and Speech in Children With a Unilateral Cleft Lip and Palate at 5 Years of Age.

This study sought to investigate the association between maxillary growth and speech outcomes for children with a repaired unilateral cleft lip and palate (UCLP) at 5 years of age. In all, 521 children (180 females and 341 males) with a nonsyndromic complete UCLP, born between 2007 and 2012 in England, Wales, and Northern Ireland were included in this study. Maxillary growth was analyzed using dental models scored by the 5-Year-Olds' index, and perceptual speech analyses were scored by the Cleft Audit Protocol for Speech- Augmented rating. Forty-one percent of the children achieved good maxillary growth (scores 1 and 2 on 5-Year-Old' index). Fifty percent of the children achieved normal speech (achieving UK speech standard 1). Maxillary growth was not found to have an impact on speech outcome when described by the 3 UK National Cleft Lip and Palate Speech Audit Outcome Standards. Analysis according to individual speech parameters showed dentalizations to be less prevalent in children with good maxillary growth compared to fair and poor growth (P = .001). The remaining speech parameters within resonance, nasal airflow, and articulation categories were not significantly associated with maxillary growth. The findings from this study suggest that children with a history of complete UCLP, who have poor maxillary growth, are not at a higher risk of having major speech errors compared to children with good or fair maxillary growth at 5 years of age.

Auditing images collected by sensors in ambient intelligence systems with privacy and high efficiency

To determine whether sensors should transmit collected images back to the data center, an auditing protocol is desired to check these images before transmission. Since images may contain sensitive information of the environment, privacy is an essential requirement for such an auditing protocol. Moreover, since sensors are typically low-power devices and the data center has to handle a variety of sensors, this auditing protocol should be lightweight. Taking both security and efficiency into account, we propose a novel auditing protocol on images in ambient intelligence systems, called AP-AmI (i.e., Auditing Protocol in Ambient Intelligence Systems). In AP-AmI, we use the local binary pattern technique for extracting features from images and design a novel privacy-preserving Euclid distance computation algorithm for determining whether these collected images are useful. Since these two techniques are both lightweight, AP-AmI can achieve high efficiency. At the same time, since feature vectors cannot be extracted by adversaries, AP-AmI can satisfy the privacy requirement. Experimental results show AP-AmI is feasible for real-world applications.