Audit Tool Research Articles

AntiHalluciNet: A Potential Auditing Tool of the Behavior of Deep Learning Denoising Models in Low-Dose Computed Tomography.

Gaining the ability to audit the behavior of deep learning (DL) denoising models is of crucial importance to prevent potential hallucinations and adversarial clinical consequences. We present a preliminary version of AntiHalluciNet, which is designed to predict spurious structural components embedded in the residual noise from DL denoising models in low-dose CT and assess its feasibility for auditing the behavior of DL denoising models. We created a paired set of structure-embedded and pure noise images and trained AntiHalluciNet to predict spurious structures in the structure-embedded noise images. The performance of AntiHalluciNet was evaluated by using a newly devised residual structure index (RSI), which represents the prediction confidence based on the presence of structural components in the residual noise image. We also evaluated whether AntiHalluciNet could assess the image fidelity of a denoised image by using only a noise component instead of measuring the SSIM, which requires both reference and test images. Then, we explored the potential of AntiHalluciNet for auditing the behavior of DL denoising models. AntiHalluciNet was applied to three DL denoising models (two pre-trained models, RED-CNN and CTformer, and a commercial software, ClariCT.AI [version 1.2.3]), and whether AntiHalluciNet could discriminate between the noise purity performances of DL denoising models was assessed. AntiHalluciNet demonstrated an excellent performance in predicting the presence of structural components. The RSI values for the structural-embedded and pure noise images measured using the 50% low-dose dataset were 0.57 ± 31 and 0.02 ± 0.02, respectively, showing a substantial difference with a p-value < 0.0001. The AntiHalluciNet-derived RSI could differentiate between the quality of the degraded denoised images, with measurement values of 0.27, 0.41, 0.48, and 0.52 for the 25%, 50%, 75%, and 100% mixing rates of the degradation component, which showed a higher differentiation potential compared with the SSIM values of 0.9603, 0.9579, 0.9490, and 0.9333. The RSI measurements from the residual images of the three DL denoising models showed a distinct distribution, being 0.28 ± 0.06, 0.21 ± 0.06, and 0.15 ± 0.03 for RED-CNN, CTformer, and ClariCT.AI, respectively. AntiHalluciNet has the potential to predict the structural components embedded in the residual noise from DL denoising models in low-dose CT. With AntiHalluciNet, it is feasible to audit the performance and behavior of DL denoising models in clinical environments where only residual noise images are available.

Critical Technologies of Audit Services

Introduction. In the context of the need to improve the quality of audit services and ensure confidence in their results on the part of interested users of reporting, it is necessary to search for “points of growth” through the development of audit tools that are not inferior in technology to modern accounting and analytics. Purpose of the study is to identify key audit tools relevant for audit assignments and expert consulting activities of auditors, and to determine the possibilities of implementing modern analytical tools to improve the efficiency, effectiveness and quality of audit services. Methods. The study used methods of critical analysis of applicable standards and best auditing practices, audit procedures for assessing the effectiveness of controls and substantive testing, risk mapping, and the abstract-logical method. Results. Key audit tools were identified and classified depending on the stage of the audit, the goal setting of the procedure (compliance or efficiency), and the qualitative characteristics of the audit assignment (customer satisfaction or rationality); General directions and differences in the development trends of audit tools and other types of auditors’ activities have been identified. Conclusion. The identified critical technologies are aimed at maximizing the efficiency of audit activities through risk-based planning, reducing the possibility of manipulating the results of procedures by means of objectification, predicting significant distortions, parameterizing risks and assessing the results of procedures, regulating the qualitative characteristics of the methods used at the levels of the audit organization and the professional association of auditors.

ANALISIS PROSES AUDIT EKSTERNAL ATAS AKUN UTANG SUATU ENTITAS IMPORTIR KOMPONEN ELEKTRONIK

Using external auditor services by business entities aims to make the financial statements presented following the actual financial condition of the entity. In addition, the urgency of using an external auditor is to ensure that there is no impropriety or discrepancy in the financial statements or information directly related to the financial statements themselves. The purpose of the research is to find out how the external auditor carries out the phase of the auditing process on the debt of the importing company that has to managed properly to bring benefits. The method used the qualitative descriptive analysis method through direct observation and interviews with KAP-PCX office staff as an auditor institution of PT. XYZ is an electronic component importer entity. The results showed that the auditing of PT XYZ's debt account carried out by KAP-PCX was performed by the auditing provisions that had been planned. KAP-PCX also maintains an independent attitude even though PT XYZ has been audited by KAP-PCX in previous periods. However, what needs to be considered is the need to replace the use of Microsoft Excel with accounting software such as ATLAS (Audit Tool and Linked Archive System) that can be used in the auditing process to make it easier and more effective.

ASSESSMENT OF AGE AND DEMENTIA FRIENDLINESS OF OTTAWA COMMUNITIES AS PERCEIVED BY PERSONS WITH DEMENTIA AND CARE PARTNERS

Abstract In Canada there are over 500,000 persons living with dementia with prevalence estimates reaching as high as 912,000 by the year 2030. Given that age is the strongest known predictor of dementia and the fact that our population is ageing, there is an urgent need to create communities that promote older adults (including those living with dementia) reaching their maximum potential and feeling welcomed and included while ageing in place. The aim of our study was to determine the utility of a tool developed using a citizen science approach with persons living with dementia and their care partners to determine how they perceive the age- and dementia-friendliness of their neighbourhoods (where they live, work, conduct business and socialise). Ten participants were recruited for a pilot study which took place over a six-week period. The project designed and tested an audit tool, accessed via a smart phone/tablet, that allowed data to be collected quickly and in real time. This audit tool also allowed participants to upload quantitative and qualitative responses (including photos of locations being audited). Participants were trained to become citizen scientists in a series of workshops where they also collaborated with researchers to develop the audit tool. During the data collection period, citizen scientists audited locations/spaces that they visited during their day and submitted their responses using the app. Our findings present a case for increased inclusion of older adults, including those living with dementia, in research and intervention programs that target the promotion of age- and dementia-friendly communities.

Leveraging computer-assisted audit tools for corporate sustainability: Evidence from Ethiopia

The existing ample literature studied the factors for adopting computer-assisted audit techniques (CAATs) by internal and external auditors, frequently ignoring their impact on the quality of audits and companies’ efficiency. This study delivers new evidence on the kinds of CAATs utilized by internal auditors, examines their adoption impact on corporate sustainability, and studies the moderating impact of company characteristics. This study used data from internal auditors in Ethiopia gathered using a survey, and the study hypotheses were tested using the partial least squares-structural equation modeling (PLS-SEM) technique. The study found a moderate utilization of CAATs by internal auditors in executing their activities. The result also revealed a highly positive impact of internal auditors’ CAAT utilization on fraud discovery in the acquisition process. The study found that the intensity of this relationship is impacted by the companies’ characteristics of management commitment. However, the size and type of the company are not impacting it. This study finding complements prior studies and helps practitioners make decisions that can improve CAAT utilization in internal audit functions for a high level of companies’ sustainability.

From Industry to Creativity and the Arts: Cultural trend analysis in the reconfiguration and cultural management of industrial spaces in Lisbon

This paper explores the transformation of former urban industrial heritage sites in Lisbon into creative ecosystems, considering the major cultural trends and mindsets that are changing the city. We analyze the current dynamics, projects, and nature of these new sites and how they have been impacted by sociocultural changes, while highlighting their base heritage. Based on a cultural triangulation, our results point to a big impact of cultural trends in the development of creative communities in former industrial heritage sites, mainly in terms of identity projects, the creation of stories, co-creation dynamics and exchange of knowledge for innovative solutions. This article contributes with a new perspective on Lisbon’s creative network; an understanding of the role of heritage in the reconfiguration of industrial sites into creative communities; offers a methodological framework to advance research on trend analysis in an applied setting of cultural and creative spaces, providing an audit tool of their nature, projects, and dynamics.

Canadian tertiary care pediatric massive hemorrhage protocols: a survey and comprehensive national review.

Hemorrhage is the leading cause of pediatric death in trauma and cardiac arrest during surgery. Adult studies report improved patient outcomes using massive hemorrhage protocols (MHPs). Little is known about pediatric MHP adoption in Canada. After waived research ethics approval, we conducted a survey of Canadian pediatric tertiary care hospitals to study MHP activations. Transfusion medicine directors provided hospital/patient demographic and MHP activation data. The authors extracted pediatric-specific MHP data from requested policy/procedure documents according to seven predefined MHP domains based on the literature. We also surveyed educational and audit tools. The analysis only included MHPs with pediatric-specific content. The survey included 18 sites (100% response rate). Only 13/18 hospitals had pediatric-specific MHP content: eight were dedicated pediatric hospitals, two were combined pediatric/obstetrical hospitals, and three were combined pediatric/adult hospitals. Trauma was the most common indication for MHP activation (54%), typically based on a specific blood volume anticipated/transfused over time (10/13 sites). Transport container content was variable. Plasma and platelets were usually not in the first container. There was little emphasis on balanced plasma/platelet to red-blood-cell ratios, and most sites (12/13) rapidly incorporated laboratory-guided goal-directed transfusion. Transfusion thresholds were consistent with recent guidelines. All protocols used tranexamic acid and eight sites used an audit tool. Pediatric MHP content was highly variable. Activation demographics suggest underuse in nontrauma settings. Our findings highlight the need for a consensus definition for pediatric massive hemorrhage, a validated pediatric MHP activation tool, and prospective assessment of blood component ratios. A national pediatric MHP activation repository would allow for quality improvement metrics.

What constitutes a high-quality environment for speech and language development?

ABSTRACT This paper discusses a study that considered how the quality of three different learning environments, indoor classrooms, outdoor classrooms and forest schools, for children aged 3–5 years, is associated with the quality of their utterances. Adopting a theoretical framework of interactionism it was found that, within the study settings (n = 4), the quality of utterances differed depending on the environment in which the children were playing and learning. The data were collected through a phased approach, firstly by undertaking interviews, with children, parents, practitioners and experts, (n = 63). These interviewee responses defined the features of a high-quality environment to promote speech and language. The second phase, using the features identified, resulted in an audit tool which was used to assess different environments. By then analysing lexical diversity, through observations (n = 43) using body-worn cameras attached to children using chest harnesses, alongside the environmental audit, a positive association was found between the quality of the environment and the quality of children’s utterances. It is asserted therefore that it is possible to define a high-quality environment, for the purposes of language development.

An exploration of national and local policies supporting health promoting sports clubs in the Republic of Ireland

ABSTRACT The societal role which sports clubs can play in promoting health has been underexploited, and sports clubs have called for support from policymakers. Based on the Health Promoting Sports Clubs National Audit Tool, the present study has as objective to investigate how national public policies support health promotion in sports clubs, by questioning indicators of quality (references to other document, policy framing and evaluation), the content (target groups, health topics, type of policy instruments) and the mechanisms used by Irish decision-makers for coordination, evaluation, dissemination and implementation of these policies. The tool was completed in two steps comprising a systematic search of policy plans, programmes or regulations and 12 interviews with key informants. A content analysis of 17 policy documents, identified 49 policy actions targeting HP in sport clubs, coming from different sectors, but only policies from the health sector considered a settings-based approach, supporting a unique sports federation programme. Policies focus on a single health behaviour, where the most targeted were physical activity participation, gender inequity and the disability gap in access to sport clubs. The policy structure lacks coordination, monitoring, media campaigns and events, and therefore not adopting the HPSC concept, but only a health education approach. Future studies should support the acknowledgement of HP as an umbrella concept, in order to support the understanding and development of organisation and system change since policies are drivers for sport federations, local sport actors and sports clubs.

Implementation of mandatory blood alcohol screening in trauma patients: A retrospective study from a tertiary trauma center in a Middle Eastern country

BackgroundAlcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption. MethodsThis was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as “negative”, and BAC >2.2 mmol/L was referred to as “BAC positive”. A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied. ResultsA total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%–85.3%), and the test positivity rate was 10% (8.6%–12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS. ConclusionDespite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.

Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities.

The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

P81: Anticholinergic Burden of Patients Assessed by UK Memory Clinics: An Audit

Objective:It is estimated that there are 55 million people living with dementias globally. With so few effective treatments available for dementias, it is vital that services optimise the management of risk factors for patients to slow their disease progression as much as possible. Commonly prescribed medications with anticholinergic effects can cause iatrogenic cognitive impairment and lead to faster decline in people living with dementia. United Kingdom (UK) national guidelines recommend minimising their use when assessing people with suspected dementia or during medication reviews of people with dementia. We proposed to audit how many people were being referred to memory assessment services in two UK locations with a significant anticholinergic burden, which medications were responsible, and whether this impacted on diagnosis.Methods:We developed an audit tool based on national guidelines to gather data on the age, gender, medications, diagnosis and cognitive impairment of the first 50 patients assessed in the Memory Assessment Services in Wolverhampton and Walsall in 2022. We used the anticholinergic effect on cognition scale (AEC) to measure patients’ anticholinergic burdens and identify the most frequently prescribed medications.Results:We collected data from 30 patients from Wolverhampton and 20 patients from Walsall. Across the two locations, only 10% presented with a significant anticholinergic burden, with 24% having some anticholinergic burden that was not considered significant. Every patient with a significant anticholinergic burden was later diagnosed with dementia.Most of the anticholinergic medications that were prescribed are generally prescribed for psychiatric or neurological indications and the most frequently prescribed drug was amitriptyline.Conclusion:The prescription of anticholinergic medications was not as prevalent as predicted in our sample. It may be that anticholinergic medication are less prescribed for physical illnesses as alternatives that do not cross the blood-brain barrier are available. Psychogeriatricians are well placed to review the anticholinergic medications that are commonly prescribed during the assessment of suspected dementia, due to their familiarity with these medications. In response to our findings, we plan to update our memory clinic assessment tools to highlight the need for clinicians to review patients’ anticholinergic burden during assessment.

Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project.

Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP. This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability. Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences. Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

OP163 Applying A Local Economic Evaluation Framework To Make Evaluations More Relevant For Local Decision Makers

IntroductionEconomic evaluation is infrequently used by local health services. To be useful to local decision makers, economic evaluations need to synthesize published evidence on effective interventions with local data and local stakeholder knowledge regarding patient and organizational contexts. A framework for local economic evaluation was applied by health economists working with a local health service to inform their decision-making regarding funding of health service delivery models to reduce hospital-acquired complications.MethodsThe framework engaged with local stakeholders to set priorities, assess the relevance of the published evidence, interpret local data, provide insight on the local context, and make recommendations to decision makers. It involved: (i) synthesizing the published evidence in a pragmatic review; (ii) determining local root causes and baseline incidence rates using local clinical and administrative data; and (iii) using expert elicitation to adjust published intervention effects to reflect the local context. This information was synthesized in a cost-consequence analysis that estimated the likely costs and effects of relevant interventions if they were implemented locally.ResultsLocal stakeholders selected hypoglycemia and urinary tract infections as targets for intervention. Tools and resources developed for each case study included: clinical audit tools and analysis files; pragmatic literature reviews with templates to present interventions to local stakeholders; an expert elicitation framework; and R code for cost-consequence analyses that apply published and elicited intervention effects to local data.ConclusionsThe framework provided a feasible and acceptable process for undertaking local economic evaluations. Engagement with local stakeholders ensured the evaluations produced were relevant and tailored to the local setting and were therefore useful to local decision makers. The tools and resources developed can be applied by other local health services. The framework itself can be used for other case studies. However, the time and cost associated with the evaluations was not sustainable and alternative models for applying the framework need to be explored.

Clinical Audit for Integration of Communicable and Non-Communicable Diseases at the Primary Health Care Level in Tanzania.

Poor quality of health care services remains an important challenge in health care delivery systems. Here, we validate clinical audit tools and describe audit results of selected clinical standards related to communicable disease (CD) and non-communicable disease (NCD) integration at the primary health care level. A multi-methods approach, including a retrospective cohort and cross-sectional design, was deployed concurrently at Health Centres. Separate evaluators assessed the Health Centres using an audit tool and the inter-rater/inter-observer reliability was estimated. The extent of adherence to clinical standards was measured in proportions for: infection prevention control, tuberculosis (TB) diagnosis including advanced TB/Human Immunodeficiency Virus (HIV), the diagnosis of chronic lung diseases, and the bidirectional screening and clinical management of TB and Diabetes Mellitus (DM). The inter-rater reliability for the clinical audit tools based on 130 individuals' charts was 99.5% (CI:99-100). The total estimated maximum score for infection prevention control was 114 and on average health centres scored 42 (37%). Only 3 (4%) of 80 individuals' medical charts with unexplained productive cough were evaluated for TB. None of the 24 individuals with HIV infection medical charts had vitals measured and only 6 (25%) patients with advanced HIV had a TB test performed, whereas 4 (17%) had a cryptococcal antigen test, and 1 (4%) had a chest radiograph. Also, 24 patients' chart from documented HIV negative with chronic cough had no records of spirometry or peak flowmeter or a chest radiograph. However, a diagnosis of asthma and chronic obstructive pulmonary disease as made in 17 (71%) and 7 (29%), respectively. TB was confirmed for 102 patients among whom only 12(12%) were screened for DM. The DM clinics had no TB presumptive registers. Patients with TB/DM (n=2) had a glycated haemoglobin (HbA1c) measurement done and received appropriate management. The developed clinical audit tools were reliable and could contribute to quality measurement for metrics-related integration of CD and NCD in Tanzania. Further investigations will determine if the clinical audit tools widely used in cycles can improve the quality of care in health care delivery systems.

Antimicrobial Point Prevalence Survey in four Emergency Departments at Manchester University NHS Foundation Trust

Abstract Introduction Antimicrobial Point Prevalence Surveys (PPS) are a recognised tool to facilitate monitoring of compliance to an organisation’s antimicrobial stewardship (AMS) programme.1 Most PPS tools used within secondary care focus on prescribing of antimicrobials for in-patients. At Manchester University NHS Foundation Trust (MFT) PPS are carried out by clinical pharmacists across all inpatient ward areas. Antimicrobials are one of the most prescribed medicines in the emergency department2 (ED) yet, the current MFT PPS tool does not facilitate undertaking PPS in EDs. A new validated outpatient PPS tool3 from the Global Point Prevalence Survey (GPPS) was released earlier this year. Aim To pilot the GPPS outpatient tool in the EDs at MFT to determine the level of compliance with the MFT antimicrobial guidelines within the EDs, estimate the total burden of antimicrobial use and describe types of infections and prescribed antimicrobials within the EDs. Methods Following the GPPS outpatient protocol3 the four emergency departments (3 general EDs, and 1 paediatric ED) at MFT were assessed in a ten-day period during May 2023. Each ED was assessed continuously for a 4-hour timeslot on a weekday morning by an AMS pharmacist who retrieved the data from the EPIC electronic patient record system remotely. All patients who were allocated a room/bedspace on ED within the timeslot were audited, including patients who were not prescribed antimicrobials. Guideline compliance was checked with the MFT antimicrobial guidelines. The online GPPS data collection tool was used, generating a data download into an Excel spreadsheet for analysis. This study was a service evaluation and so did not require ethical approval. Results 180 patients were audited from 4 EDs yielding a total of 41 prescriptions for antimicrobials. 28/180 patients were prescribed one or more antimicrobial, with an overall antimicrobial prescribing rate of 15.5%. Prescribing was higher in the paediatric ED with a rate of 25%. 92.7% (38/41) of antimicrobials were prescribed intravenously (IV). Choice of antimicrobial was compliant in 38/41 (92.7%). Dose was compliant in 40/41 (97.6%). Duration of treatment was compliant in 39/41 (95.1%). Sepsis accounted for 48.8% of indications. 2/41 prescriptions were based on the C Reactive Protein (CRP) biomarker. Discussion/Conclusion Whilst the study was only conducted over a short time period, the findings suggested that overall compliance with the MFT antimicrobial guidelines was very good. The prescribing rate of 15.5% was low in comparison to the recent MFT inpatient PPS which showed a prescribing rate of 30%. There is a high rate of diagnosis of sepsis and prescribing of IV antimicrobials in comparison to orals which may be anticipated in the emergency setting. The GPPS outpatient audit tool provided an opportunity to do a baseline assessment within the EDs across MFT, providing data on prevalence of antimicrobial prescribing and compliance to the MFT guidelines. The GPPS audit tool did not have the utility to review the accuracy of clinical diagnosis of severe infection/sepsis within the ED, or the appropriateness of IV antimicrobial prescribing. Further research should be undertaken to provide assurance on the clinical diagnosis of severe infection and the appropriateness of IV antimicrobial prescribing with the EDs.

Improvement of violence management among nurses in Iran: The best practice implementation project in a health promoting hospital.

This project aimed to assess compliance with evidence-based criteria' for the prevention and management of workplace violence against nursing staff in Shahid-Beheshti hospital, Maragheh, Iran. Workplace violence is a managerial and workplace occupational health and safety issue that can affect the performance of an institution. Further, it might turn the work environment into an insecure and hostile one which can influence the performance of employees and their professional relationships negatively. Nevertheless, staff have their own legal rights, and their organizations are legally and ethically in charge of providing them with safe work environments. Following the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool with three phases of activities, this project utilized an implementation framework incorporating quality improvement. Furthermore, the audit tool was used to establish the project and set up the measurement and evaluation of three evidence-based criteria. The post-implementation audit results indicated a significant improvement in violence management and prevention. The compliance rate on the first criterion, i.e. aggression management training, increased from 49% at baseline to 81% at the end. The second criterion, i.e. timely support and assistance following an incident, exhibited greater increase from eight to 73%. Finally, an increased compliance was noted on the third criterion, i.e. policy for risk management and safe environment, from 22 to 77%. The current project successfully implements evidence-based violence management in Shahid-Beheshti hospital. It reveals significant results on compliance and the increasing knowledge of nurses on evidence-based stress management, communication skills and self-companion.

Research- vs. government-driven physical activity policy monitoring: a systematic review across different levels of government

BackgroundEven though the importance of physical activity policy monitoring has increased in the last decade, there is a lack of understanding what different approaches exist and which methodology they employ. In order to address this research gap, this review attempts to map existing approaches of physical activity policy monitoring and to analyse methodological aspects, especially with regards to the roles of governments and researchers.MethodsA systematic search was conducted in five scientific databases (PubMed, Scopus, SportDiscus, Psycinfo, Web of Knowledge) in July 2021, and the identified records were screened independently by two reviewers. Records were included if they (a) focused on the monitoring of public policies to promote PA, (b) allowed to compare policies across time, across nations/regions or across policy sectors, and (c) were written in English, German or Russian. During full text analysis, information on methodological aspects was extracted and studies were categorized based on the level of government involvement.ResultsThe search yielded in a total of 112 studies. 86 of these studies (76.8%) followed a research-driven approach (little or no government involvement) while only two studies (1.8%) were based on a government-driven approach (led by governments). The remaining 24 studies (21.4%) were based on a co-production approach (strong collaboration between researchers and governments). All in all, 18 different tools for physical activity policy monitoring were identified; key examples are the Report Cards on Physical Activity for Children and Youth (research-driven approach), the HEPA Monitoring Framework (government-driven approach) and the HEPA Policy Audit Tool (co-production approach).ConclusionsThe level of government involvement in policy monitoring differs significantly, and research-driven, government-driven and co-production approaches can be distinguished. These approaches have different strengths and weaknesses, and can be linked to distinct theories of change and models on research-policy relations. Increasing awareness on the implications of these approaches is key to improve the understanding and further development of physical activity policy monitoring.

A novel approach for a pre-assessment of textile innovation process: innovation gap finder model (IGFM)

PurposeThe textile industry is a labor-intensive industry in which where innovation-oriented studies are conducted intensively. However, identifying potential innovation gaps for a firm operating in the textile industry is not easy and greatly influences the firm's future success. To this end, this study aims to propose a novel integrated approach for the pre-assessment of the firm-level innovation process.Design/methodology/approachThe proposed approach uses two important tools: the technology capability audit tool and innovation audit tool. The proposed approach integrates these tools to discover possible innovation opportunities for firms. The proposed approach is called the innovation gap finder model (IGFM).FindingsA real case study in the textile industry is conducted to show how IGFM works in practice. The results of this study show that decision-makers can easily identify existing innovation gaps using IGFM.Originality/valueFirms must first identify innovation gaps in order to initiate achievable projects in line with their current situation. Addressing a firm-level pre-assessment of the textile innovation process helps achieve growth and enables the firm to know what it should do in the near future. By identifying innovation gaps by considering the innovation processes at the firm level, it is also easier to prepare an action plan on what and how to do in accordance with the firm's own culture. There is no specific tool developed to discover potential innovation gaps in the literature. To fill this gap, a novel integrated approach is proposed for a pre-assessment of firm level innovation process in this study. The proposed approach can also accelerate the establishment of the “idea-invention-innovation” path within the firm.

Fraud in Financial Institutions: The Contribution of Bengkulu Bank Internal Audit

This research explores the key role internal audit plays in mitigating fraud risk. We revealed that internal audit actively examines financial transactions, evaluates internal control procedures, and identifies potential fraud risks. With internal audit's strong competence and team structure, they are at the forefront of protecting banks from fraud risk. Risk evaluation is an essential step in fraud prevention, and this research highlights how internal audit continuously conducts risk evaluations to identify the most vulnerable areas. A fast and effective fraud detection process is also emphasized in this study, where Bank Bengkulu's internal audit has built sophisticated audit tools and techniques to detect suspicious patterns in real-time. While internal audit plays a crucial role in fraud prevention, the research also identified several obstacles and challenges internal audit teams face. In particular, technological developments and increasingly sophisticated fraud demand proactive measures and investment in resources, education, and training. This research confirms that the internal audit at Bengkulu Bank significantly contributes to maintaining the integrity and stability of the bank's operations. In the face of increasingly complex fraud threats, constant efforts in developing internal audit capabilities are essential to protect banks from fraud risks.