Cent Compliance Research Articles

Is Institutional Review Board (IRB) Doing Its Job Right? How To Assess This.

To audit the performance of the institutional review board at a cancer hospital. The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, in 2021, and comprised all records of the institutional review board from 2005 to 2021. The audit was based on a tool created by the Association for the Accreditation of Human Research Protection Programmes, and elements evaluated included terms of reference, membership lists, review records, meeting minutes, institutional research guidelines as well as other relevant policies. The institutional review board was found to be in 100% compliance with all the elements set forth in the Association for the Accreditation of Human Research Protection Programmes. The institutional review board was found to be an independent body with a diverse membership and the chairman was always an unaffiliated member. It had defined processes in line with relevant laws and guidelines. Review of research studies was devised to promote the ethical conduct of research. Though a self-assessment, the audit objectively showed that the institutional review board was in cent per cent compliance with the evaluation instrument developed and used by the Association for the Accreditation of Human Research Protection Programmes. Nevertheless, it still needs further discussion as to how high levels of efficiency and performance of institutional review boards ultimately provide a higher degree of protection to human research participants.

Sustainable management of water utility in Samoa through services improvement with Okinawa Water Bureaus

This study examines how Samoa improved the capacity of Samoa Water Authority (SWA) by implementing integrated cooperation with water utilities in Okinawa Prefecture, and hardware and software development to reduce the high non-revenue water (NRW) ratio and improve water supply quality and inadequate water pressure. Standard operation procedures were formulated to enhance the capacity of SWA. The cooperation method adopted continuous on-the-job training with a bottom-up approach. Consequently, the NRW ratio was reduced from 68 per cent to 36 per cent and water supply with proper pressure was achieved in the targeted area. The quality of the tap water, in which many coliform bacteria were detected before the cooperation, achieved 100 per cent compliance with standards. The cooperation evidenced that improving water services can help users’ understanding of tariff payments, although the water tariff increased for most consumers due to a shift from fixed to metered tariff.

Impact of enhanced recovery after surgery protocol compliance on patients\u2019 outcome in benign hysterectomy and establishment of a predictive nomogram model

BackgroundEnhanced recovery after surgery (ERAS) pathways have been shown to improve clinical outcomes after surgery. Considering the importance of patient experience for patients with benign surgery, this study evaluated whether improved compliance with ERAS protocol modified for gynecological surgery which recommended by the ERAS Society is associated with better clinical outcomes and patient experience, and to determine the influence of compliance with each ERAS element on patients’ outcome after benign hysterectomy.MethodsA prospective observational study was performed on the women who underwent hysterectomy between 2019 and 2020. A total of 475 women greater 18 years old were classified into three groups according to their per cent compliance with ERAS protocols: Group I: < 60% (148 cases); Group II:≥60 and < 80% (160 cases); Group III: ≥80% (167 cases). Primary outcome was the 30-day postoperative complications. Second outcomes included QoR-15 questionnaire scores, patient satisfaction on a scale from 1 to 7, and length of stay after operation. After multivariable binary logistic regression analyse, a nomogram model was established to predict the incidence of having a postoperative complication with individual ERAS element compliance.ResultsThe study enrolled 585 patients, and 475 completed the follow-up assessment. Patients with compliance over 80% had a significant reduction in postoperative complications (20.4% vs 41.2% vs 38.1%, P < 0.001) and length of stay after surgery (4 vs 5 vs 4, P < 0.001). Increased compliance was also associated with higher patient satisfaction and QoR-15 scores (P < 0.001),. Among the five dimensions of the QoR-15, physical comfort (P < 0.05), physical independence (P < 0.05), and pain dimension (P < 0.05) were better in the higher compliance groups. Minimally invasive surgery (MIS) (P < 0.001), postoperative nausea and vomiting (PONV) prophylaxis (P < 0.001), early mobilization (P = 0.031), early oral nutrition (P = 0.012), and early removal of urinary drainage (P < 0.001) were significantly associated with less complications. Having a postoperative complication was better predicted by the proposed nomogram model with high AUC value (0.906) and sensitivity (0.948) in the cohort.ConclusionsImproved compliance with the ERAS protocol was associated with improved recovery and better patient experience undergoing hysterectomy. MIS, PONV prophylaxis, early mobilization, early oral intake, and early removal of urinary drainage were of concern in reducing postoperative complications.Trial registrationChinese Clinical Trial Registry, ChiCTR1800019178. Registered on 30/10/2018.

Undertaking the surgical count: An observational study

Objective To systematically measure and describe perioperative nurses’ surgical count practices using the Surgical Count Observational Tool, to measure conformity with standardised processes and identify barriers and enablers influencing nurses’ practices. Sample and setting A large public tertiary hospital in Western Australia. Methods The Surgical Count Observational Tool (SCOT) was developed using the Content Validity Index over two Delphi panel rounds and then pilot tested. Individual observations were analysed according to 14 criteria based on the 2016 Australian College of Perioperative Nurses (ACORN) standard ‘Management of accountable items used during surgery and procedures’1. Count processes were observed over two consecutive weeks across six specialist perioperative teams including nurses, surgeons, anaesthetists and technicians to measure compliance with the ACORN standard. The SCOT and a field diary were then used in an observational study of 83 nursing staff, including 54 circulating nurses and 29 instrument nurses, over a period of 57 hours. Interrater reliability was calculated using Cohen’s kappa. Descriptive statistics were used to analyse observational data. Results Of the 1268 count practices observed, 759 were compliant with the ACORN standard, representing a 60 per cent compliance rate. Conclusion Consistency and compliance rates were lower than expected. Patient, case, environmental factors and expectations of surgeons and co-workers were observed to act as barriers to best practice in perioperative nurses undertaking a surgical count, while nurse’s knowledge was observed to act as an enabler.

A multidisciplinary evaluation of suspected, non-confirmed cases of COVID-19 including chest CT, as compared to World Health Organization recommendations

AIMTo report an audit of the evaluation of suspected, unconfirmed cases of COVID-19 including chest computed tomography (CT), as compared to World Health Organization recommendations.METHODSA clinical audit was undertaken examining the evaluation of patients with suspected COVID-19 with negative SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) results, with comparison to WHO recommendations. A retrospective chart review was undertaken for 90 patients examining investigations, in particular CT, used to clarify the diagnosis.RESULTSNinety patients underwent additional investigation. Seventy-five per cent adherence to WHO recommendations was observed. Fifty-two men (57.78%) and 38 (42.22%) women were investigated, with a median age of 69 years (range 20–96 years). Seventy-nine chest CT examinations demonstrated positive, indeterminate, and negative rates for COVID-19 of 3.79%, 24.1%, and 72.15% respectively. Three patients had discordant swab results with initially negative and subsequently positive results for SARS-CoV-2, resulting in false-negative rates of 5.1% for those retested. Combining discordant RT-PCR swab results, positive radiology, and patients treated as COVID-19-positive due to indeterminate radiology and highly consistent symptoms, resulted in a false-negative rate for initial SARS-CoV-2 RT-PCR swabs of 16.67%.CONCLUSIONSeventy-five per cent compliance with relevant WHO guidance and a false-negative rate for initial swabs of 16.67% was demonstrated. Further evidence is needed to fully determine the utility of chest CT in the diagnosis of COVID-19 in the context of initial false-negative RT-PCR results.

Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

ObjectiveThe aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and...

A Multidisciplinary Approach to Improving SCIP Compliance

The Surgical Care Improvement Project (SCIP) is a national program aimed at reducing perioperative complications and is a quality benchmark metric for Centers for Medicare and Medicaid Services. This study evaluates whether a multidisciplinary program improved an institution's compliance with SCIP measures. Analysis of the facility's performance data identified three key areas of SCIP noncompliance: 1) timely discontinuation of perioperative antibiotics and urinary catheters, 2) initiation of venous thromboembolism prophylaxis, and 3) perioperative beta blocker administration. Multidisciplinary teams collaborated with providers and department chairs in reviewing and enable SCIP compliance. Anesthesia staff managed preoperative antibiotics. SCIP-compliant order sets, venous thromboembolism pop-up alerts, and progress note templates were added to the electronic medical record. Standardized education was provided to explain SCIP requirements, review noncompliant cases, and update teams on SCIP performance. Data were captured from January 2009 to March 2014. Ten SCIP fallouts were reported for general surgery specialties in January 2013, when the SCIP compliance project launched. Specifically, colon-related surgery achieved 100 per cent compliance. Six months after implementation, overall SCIP compliance at our institution improved by 65 per cent (from 90.7-98.6% compliance).

Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins

BackgroundThis was a prospective study of radiofrequency segmental thermal ablation (RFA) for the treatment of incompetent varicose great saphenous veins (GSVs). The present report describes long-term follow-up at 5 years.MethodsThe 5-year follow-up of this multicentre European study included assessment of the Venous Clinical Severity Score (VCSS), and GSV occlusion and reflux on duplex imaging.ResultsA total of 225 patients had 295 GSVs treated by RFA, achieving an initial vein occlusion rate of 100 per cent. With 80·0 per cent compliance, Kaplan–Meier analyses showed a GSV occlusion rate of 91·9 per cent and a reflux-free rate of 94·9 per cent at 5 years. Among the 15 GSVs noted with reflux during follow-up, only three showed full recanalization of the GSV at 1 week, 6 months and 3 years. Of the 12 legs with partial recanalization, reflux originated at the saphenofemoral junction in ten, with a mean length of the patent segment of 5·8 (range 3·2–10) cm; only six patients were symptomatic. Mean(s.d.) VCSS scores improved from 3·9(2·1) at baseline to 0·6(1·2), 0·9(1·3) and 1·3(1·7) at 1, 3 and 5 years.ConclusionAt 5 years RFA proved to be an efficient endovenous treatment for incompetent GSVs in terms of sustained clinical and anatomical success for the vast majority of treated patients.

Digest

AbstractDementia care is one of the two new targets of the Department of Health's Commissioning for Quality and Innovation (CQUIN) payment framework introduced for 2012/13. The aim is to incentivise the identification of dementia and other causes of impaired cognition in patients over 75 years admitted to hospital as emergency cases and to encourage appropriate referral and follow up after they leave hospital. The pathway has three stages: identification, diagnostic assessment and investigation to determine the possibility of dementia, and referral for specialist diagnosis. The CQUIN payment is triggered by a 90 per cent compliance rate.The Department of Health has published a guide to the new goals (available at www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133859.pdf).

Survey of the needs of patients in a private nursing home: a pharmacist's view

Abstract Validated data collection instruments were used to assess the health status and existing drug therapy of 79 patients (16 male, 63 female; mean age 84 [±9] years) in two private nursing homes in Norfolk. The homes had already been found to be above average standard in terms of medicines supply, storage and administration. The most common symptoms of long term chronic disease were associated with neurological, cardiovascular, arthritic, psychiatric or diabetic diagnoses. Fifty nine patients had some memory impairment; 77 suffered from additional health problems which could arise from inappropriate therapy or dosing. All patients received most of their medicines from nursing staff. The mean (±SD) number of items received per day was 7.1 (±3.4). Of drugs prescribed for regular use, 79 per cent were given in accordance with the wishes of the prescriber. In contrast, only 21 per cent of medicines prescribed for use when necessary (prn) were given as intended. Thirty three per cent of prn medicines, some prescription only, had been given in the absence of any GP knowledge or instruction. Although there were written procedures for drug administration, there was only 58 per cent compliance with these guidelines. Drug administration charts proved to be an incomplete record of pre-existing drug allergy, topical application, self-medication and drugs used in routine nursing procedures, eg, bladder washouts.

Influencing prescribing in primary care: a collaboration between clinical pharmacology and clinical pharmacy

Abstract A study was carried out to determine whether the standard of prescribing in primary care can be improved by a therapeutics advisory service provided by a consultant clinical pharmacologist and a clinical pharmacist. Audit, feedback, peer review, guidelines, target setting and small group teaching were used to influence behaviour in two fundholding practices: a four partner semi-rural practice in Staffordshire (practice A) and a five partner urban practice in Shropshire (practice B), both of whom paid for the therapeutics advisory service from their practice funds. The main outcome measures were changes in prescribing and disease management. Practices A and B showed a 62 per cent and 28 per cent compliance, respectively, with recommendations for making financial savings. Blood pressure control improved in both practices, with the proportion of patients with blood pressure readings less than 160/90 mmHg rising from 47 per cent to 65 per cent in practice A, and from 53 per cent to 72 per cent in practice B, over the study period. After an intervention, the percentage of patients with non-valvular atrial fibrillation who were anticoagulated rose from 24 per cent to 57 per cent at practice B. Adherence to guidelines on the use of omeprazole by the two practices occurred in 41 per cent and 42 per cent of prescriptions, respectively, after one year, improving to 58 per cent and 56 per cent after a further year. The approach of peer group audit, education and clinical pharmacy support was well accepted by the GPs, and early results show it may have led to an improvement in the standard of prescribing.

Quality improvement in community pharmacy practice

Abstract Focal points

Improving Participation and Quality of Clinical Research in a University-Based General Surgery Residency Program

At a university-based general surgery training program, post-graduate year (PGY) to 5 categorical general surgery residents had been required to complete an annual clinical research project and a year of laboratory research. Since the 80-hour work week, the laboratory experience was made optional, with a resultant decline in laboratory and clinical participation by 50 per cent and 75 per cent, respectively. Our goal was to review the effect of a simple programmatic intervention on the research compliance rate and quality. The Department was informed about the clinical research requirement via e-mail, memo, and announcements. Faculty submitted lists of novel or on-going projects. This was compiled and e-mailed to the Department with a list of project milestones. This included identification of a research mentor and project, Human Subjects Course certification, institutional review board submission dates, a midyear progress report, and final submission date. Rates of compliance and nature of research were recorded the year before and the 2 years after the intervention. Before the intervention, 2 of 16 residents were compliant. Faculty submitted 76 projects for resident review. One hundred per cent compliance with all aspects of the program was seen at the end of both year 1 and 2. Case reports rate fell from 65, to 30, to 25 per cent by the end of year 2. Publications increased from three preintervention to 13 by year 2. Presentations increased from five preintervention to 13 by end of year 2. This study demonstrates that small inexpensive interventions can have a dramatic effect on research participation.

Audit of management of periorbital cellulitis and abscess in a district general hospital and a tertiary referral centre, in line with published guidelines

To audit the management of periorbital cellulitis or abscess, in line with guidelines published in 2004, within a district general hospital and a tertiary referral centre. Retrospective audit analysing 58 cases at a district general hospital and 61 cases at a tertiary referral centre, encountered since 2004. At the tertiary referral centre, 22 patients were diagnosed with pre-septal cellulitis and discharged, as were 20 cases at the district general hospital. At the tertiary referral centre, 95 per cent of patients were correctly seen by an ophthalmologist and 82 per cent by a senior ENT surgeon, compared with 63 and 39 per cent, respectively, at the district general hospital. In both centres, one patient did not receive a computed tomography scan where this was indicated. Despite the need for twice daily monitoring of ophthalmological criteria, both sites lacked 100 per cent compliance. At the tertiary referral centre, 76 per cent of patients were correctly treated with intravenous antibiotics, compared with 68 per cent at the district general hospital. At both sites, adherence to guidelines was suboptimal. Management may be improved through improved education and online information support.

Hindu philosophy: bridging corporate governance and CSR

PurposeThe purpose of this paper is to highlight how fast the divide between the good corporate governance (CG) and corporate social responsibility (CSR) is declining. The concepts covered under CG and the areas covered under CSR are no longer distinctive. Both the philosophies advocate doing good and disclosing the good done.Design/methodology/approachThe study does a brief survey of Indian mythology to make its point clear that Indian philosophy is positive and it inculcates positive values in Indians, which influence their socially responsible behaviour. The study further analyses the annual reports of 50 Indian private corporate houses to show the extent of CG and CSR undertaken by them. The information is shown in the tabular form or in statement form, both are included for the purpose of the study.FindingsIn India, the CG practices are mandatory as per the clause 49 of the listing agreement of Securities and Exchange Board of India (SEBI) for all the companies listed on recognized stock exchanges of India. However; there are two parts of disclosure – mandatory and non‐mandatory. In so far as mandatory requirements are concerned, 100 per cent compliance exists. But with regard to non‐mandatory requirements the results are quite disheartening. Similarly, when the study analyzed the annual reports to examine the extent of corporate responsibility disclosure the results are equally discouraging for reasons discuss below in the introduction part of the paper.Originality/valueThe study has revealed certain awakening facts, which will serve as a useful guide for policy formulation in relation to Indian corporate sector.

A Prospective Study of Nurse and Patient Education on Compliance with Sequential Compression Devices

Sequential compression devices (SCD) have become the most common form of prophylaxis against the formation of deep venous thrombosis (DVT) among surgical patients. However, compliance with SCD has traditionally been poor. The aim of this study was to assess the affect of patient and nurse education by surgeons on SCD compliance. This was a prospective study involving a single teaching hospital. Compliance was checked twice daily. The main outcomes were compliance rates with SCD use before and after nurse and patient education. Nurses were not aware of the study. Surgical floors had a history of resident and attending interactions regarding SCD, whereas nonsurgical floors did not. A handout that emphasized SCD importance was also given to patients on surgical units. Before education, surgical units had a compliance rate of 61.5 per cent, whereas nonsurgical units had a 48 per cent compliance rate. This difference was significant (P = 0.014). After nursing and patient education on the busiest surgical floor, compliance rates on the surgical ward increased to 65 per cent, a difference that was not of statistical significance (P = 0.515). A nursing unit's daily experience is the most important factor in their compliance rates with SCD use. Focused nursing lectures and patient education may have incremental value.

Compliance with short-term oral antibacterial drug treatment in dogs.

Compliance with a 10-day course of oral antibacterial drugs in dogs being treated as outpatients at a veterinary clinic was assessed by use of pill count data obtained by telephone interview. The association between compliance and several possible determinants of compliance was investigated. Ninety-five animal owners were included in the study, with 44 per cent reporting 100 per cent compliance with the treatment regimen and as many as 88 per cent reporting a compliance level of 80 per cent or more. The compliance level was significantly higher (P < 0.002) when the animal owners felt that the veterinarians spent enough time on the consultation. Moreover, compliance was significantly higher (P < 0.05) for dogs being treated for gastrointestinal infections compared with those being treated for other diseases.

Hepatitis B vaccination status of medical officers at The Canberra Hospital

In November 1996, a study was conducted to determine the proportion of doctors fully vaccinated against the hepatitis B virus (HBV) at The Canberra Hospital (TCH) and identify the reasons for either non- or inadequate vaccination. TCH currently recommends that all heath-care workers maintain an HBV antibody level above 100mIU/ml Antibody levels should be checked, and a booster vaccination given if required, every 3 to 5 years.In all, 269 confidential, coded questionnaires were distributed to the entire medical staff, including interns, residents, registrars, visiting medical officers and staff specialists. They were asked whether they were immunised against HB and, if so, when they were vaccinated and how many doses they had received. The doctors were also asked if their antibody level was tested post-vaccination and, if so, the result. If vaccination did not occur or was incomplete, the reason for this was requested. Participants were also asked if they considered themselves at risk of acquiring HBV.The 177 questionnaires (66 per cent) returned showed an overall 87 per cent compliance with the recommended staff HBV vaccination schedule. Sixty per cent of respondents were vaccinated more than 5 years ago, while 27 per cent either had not had or could not recall having a post-vaccination HBV antibody test. Where an HBV antibody test had been performed, 60 per cent of responders knew that their antibody level was >100 mIU/ml.Results of the study indicate that, although the level of HBV protection in TCH medical staff is comparable with reported vaccination rates of similar groups overseas, compliance with the recommended schedule for this at-risk group of health-care workers is sub-optimal.

Tricuspid annuloplasty: A modified technique

Fifty patients with rheumatic multivalvular disease underwent a modified form of semicircular tricuspid annuloplasty for acquired tricuspid insufficiency along with mitral or mitral and aortic valve procedures. The modification allowed simulataneous tying of annuloplasty sutures and digital assessment of the tricuspid regurgitation on unsupported normothermic beating heart. Early postoperative assessment showed 8 (17.3%) patients with no regurgitation, 36 (78.2%) with trivials to mild regurgitation and 2 (4.3%) with moderate regurgitation. There were 4 (8%) early deaths not related to the tricuspid lesion. Over a follow-up period of 6–84 (mean 38) months with around 70 per cent compliance, only three patients showed progression of tricuspid regurgitation. In all other patients the tricuspid regurgitation remained controlled. The study suggests that the modified annuloplasty technique used is an efficient way to achieve predictable annuloplasty results.

Prediction of Compliance with a Post‐Myocardial Infarction Home‐Based Walking Programme

This study was undertaken to determine the personal, medical and psychological factors which may predict non‐compliance with a home‐based, moderate‐intensity walking programme in post‐infarction patients. Thirty male patients, aged 32 to 75 years, underwent a six week walking programme. After an introductory interview, the patients completed a self‐administered questionnaire and maintained an exercise log book, indicating exercise frequency and duration for a six week period. Compliance was expressed as percentage duration and percentage frequency for the total six week period. The results showed an 86 per cent compliance rate to the exercise programme. It was concluded that such training is a valuable and economical strategy in cardiac rehabilitation programmes.