Audit Data Research Articles

OPTIMIZATION OF RADIATION PROTECTION IN PATIENTS THROUGH IMPLEMENTATION OF LOCAL DIAGNOSTIC REFERENCE LEVEL (DRL) IN PANORAMIC DENTAL EXAMINATION IN RADIOLOGY INSTALLATION OF PROF. DR. MARGONO SOEKARJO HOSPITAL

One of the principles of radiation protection is optimization. Optimization is done to make the dose received as low as reasonably achievable (ALARA) by considering economic and social factors. Implementation of radiation protection optimization can be done with dose management through the Local Diagnostic Reference Level (DRL). In recent years, the Nuclear Energy Regulatory Agency (BAPETEN) has set the Indonesian DRL value for several X-ray modalities, including dental panoramic. This study was motivated by panoramic patient dose audit data using the auto mode exposure factor, which operators often use. The method for determining the manual mode exposure factor is carried out by comparing the image quality of the current variations of 6.3 mA, 8 mA, 10 mA, 13 mA, and 16 mA with a fixed voltage of 66 kV and a time of 14.1 seconds. The local DRL value was obtained by comparing the dental panoramic auto mode measurements with manual mode using certain exposure factors according to the recommendations in the initial study using a head phantom. This study used 100 patient data with adult human criteria aged over 15. The results obtained from the initial study and questionnaires in manual mode were the values that had the highest CNR and SNR at a current variation of 10 mA. The exposure factor was then used to collect patient data. The local DRL value obtained for auto mode was 83.35 mGy cm2; in manual mode, it was 57.7 mGy cm2. Manual mode exposure factors in dental panoramic examinations affected the implementation of local DRL values with a decrease of 30.77% from auto mode. The use of manual mode in dental panoramic examinations significantly reduces the radiation dose received by patients, so the use of manual mode is one of the steps to optimize radiation protection. Keywords: Diagnostic Reference Level (DRL), optimization of radiation protection in patients, dental panoramic.

Cumulus: Blockchain-Enabled Privacy Preserving Data Audit in Cloud

Data owners upload large files to cloud storage servers, but malicious servers may potentially tamper data. To check integrity of remote data, Proof of Retrievability (PoR) schemes were introduced. Existing PoR protocols assume that data owners and third-party auditors are honest and audit only the potentially malicious cloud server to check integrity of stored data. In this paper we consider a system where any party may attempt to cheat others and consider collusion cases. We design a protocol, Cumulus, that is secure under such adversarial assumptions and use blockchain smart contracts to act as mediator in case of dispute and payment settlement. We use state channels to reduce blockchain interactions in order to build a practical audit solution. The security of the protocol has been proven in Universal Composability (UC) framework. Finally, we illustrate several applications of our basic protocol and evaluate practicality of our approach via a prototype implementation for fairly selling large files over the Ethereum platform. We evaluate the prototype and show that our scheme has comparable performance.

Internal audit quality and accounting information comparability: Evidence from China.

This study employs the impact and mechanism of internal audit quality on the comparability of corporate accounting information. Using manually collected internal audit data, the study focuses on non-financial listed companies of A-share market spanning from 2007 to 2022 in China. The findings are as follows: (1) Internal audit significantly enhances the comparability of accounting information, the higher the quality of internal audit, the more pronounced its contribution. This conclusion remains robust after conducting endogeneity tests. (2) Mechanism testing reveals that internal audit enhances accounting information comparability through two channels: mitigating agency costs and improving financial information transparency. (3) Moderation effect test proves that the quality of internal control and the high-tech industry will strengthen the positive relationship between internal audit and comparability of accounting information, while the degree of industry competition and the level of capital occupation by major shareholders will weaken the positive relationship.

The role of electronic data capture systems in clinical trials: Streamlining data integrity and improving compliance with FDA and ICH/GCP guidelines

This study investigates the transformative role of Electronic Data Capture (EDC) systems in clinical trials, emphasizing their impact on data integrity, compliance with regulatory standards, and the efficiency of trial processes. The purpose of the research was to critically analyze how EDC systems align with FDA and ICH/GCP guidelines, addressing the complexities of modern clinical trials. By conducting a detailed literature review, the study explores the benefits, challenges, and technological advancements associated with EDC systems. Key findings highlight the significant advantages of EDC systems in enhancing data accuracy, real-time monitoring, and facilitating regulatory compliance through secure data management and audit trails. The study also identifies several challenges, including high implementation costs, data privacy concerns, and integration issues with other digital trial technologies. Technological advancements, such as artificial intelligence, blockchain, and decentralized trial models, are explored as promising solutions to these limitations, offering new avenues for optimizing clinical trial management. The study concludes that EDC systems have revolutionized clinical trials, streamlining data collection and analysis while ensuring compliance with stringent regulatory requirements. It recommends continued investment in EDC technologies, enhanced training for trial staff, and the integration of cutting-edge innovations to ensure future clinical trials' success.

Variation in surgery postponement rates in the NHS in England.

Postponement of surgery at preoperative assessment in the days or weeks before the patient is admitted for surgery, as distinct from cancellation on the planned day of surgery, can be devastating for patients and an inefficient use of finite resources. However, postponements are often poorly recorded. The primary aim of this pilot study was to investigate elective surgical postponement rates during or after preoperative assessment across England, and the reasons for postponement for patients on an elective surgical pathway. A retrospective analysis of clinical audit data from 16 National Health Service (NHS) trusts in England was undertaken. Data were collected during a two-week period in March 2024 on all postponements within a service. The primary outcome of interest was the postponement rate. Some 8000 case notes were reviewed. There were 583 (7.3%) postponements. Postponement rates across trusts varied from 31.9% to 1.0%. Significantly shorter time from referral to preoperative assessment was observed for day-case patients, urgent patients, patients without early screening and patients without a 'to come in' date in place. Of the 342 routine patients, 293 (85.7%) had postponements for medical rather than pathways or process reasons. Half of all routine patients waited over 94 days and a quarter of patients waited 198 days from being added to a patient tracking list to preoperative assessment. Minimizing postponements and improving preoperative assessment efficiency should be part of wider initiatives to streamline perioperative pathways.

Oral Nutritional Supplementation in Older Adults with a Hip Fracture-Findings from a Bi-National Clinical Audit.

Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision. An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS. Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17). ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished.

Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)

Abstract Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs 75% of white women, p < 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p < 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p < 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities. Key messages • Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues. • Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.

A Decentralized Digital Watermarking Framework for Secure and Auditable Video Data in Smart Vehicular Networks

Thanks to the rapid advancements in Connected and Automated Vehicles (CAVs) and vehicular communication technologies, the concept of the Internet of Vehicles (IoVs) combined with Artificial Intelligence (AI) and big data promotes the vision of an Intelligent Transportation System (ITS). An ITS is critical in enhancing road safety, traffic efficiency, and the overall driving experience by enabling a comprehensive data exchange platform. However, the open and dynamic nature of IoV networks brings significant performance and security challenges to IoV data acquisition, storage, and usage. To comprehensively tackle these challenges, this paper proposes a Decentralized Digital Watermarking framework for smart Vehicular networks (D2WaVe). D2WaVe consists of two core components: FIAE-GAN, a novel feature-integrated and attention-enhanced robust image watermarking model based on a Generative Adversarial Network (GAN), and BloVA, a Blockchain-based Video frames Authentication scheme. By leveraging an encoder–noise–decoder framework, trained FIAE-GAN watermarking models can achieve the invisibility and robustness of watermarks that can be embedded in video frames to verify the authenticity of video data. BloVA ensures the integrity and auditability of IoV data in the storing and sharing stages. Experimental results based on a proof-of-concept prototype implementation validate the feasibility and effectiveness of our D2WaVe scheme for securing and auditing video data exchange in smart vehicular networks.

Medication Regimen Complexity and Patient-Centred Outcomes in Patients Undergoing Peritoneal Dialysis.

Although patients undergoing peritoneal dialysis (PD) typically have complex treatment needs, the effect of medication regimen complexity on patient outcomes has not been thoroughly evaluated. This study aims to quantify medication regimen complexity and evaluate patient-centred outcomes including medication adherence and its determinants in patients undergoing PD. This study combined a retrospective audit of baseline data with a prospective evaluation of patient-related outcomes among patients undergoing PD at a large metropolitan dialysis centre in Australia. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI), while patient outcomes were evaluated with validated self-reported questionnaires, including the 4-item Morisky-Green-Levine Scale (MGLS), EQ-5D-5L and EQ VAS. A total of 131 patients participated [median age 67 (IQR 57-74) years]. Patients on PD were found to have complex medication regimens with an average MRCI score of 28.6 ± 11.4. Over half of the participants were deemed to be adherent to their prescribed medications as measured by the MGLS (n = 79; 60.3%). Male participants were more likely to be non-adherent to medications compared to female participants (OR 2.465; 95% CI 1.055-5.759). Participants with higher serum phosphate levels were 2.5 times more likely to report non-adherence to their medications (OR 2.523; 95% CI 1.247-5.104), while a higher health-related quality of life (HRQoL) was associated with medication adherence (OR 0.151, 95% CI 0.031-0.732). Patients on PD are prescribed complex medication regimens in addition to PD treatments that they perform at home. Patients on PD who were adherent to their medications had significantly better outcomes in terms of HRQoL and serum phosphate levels compared to non-adherent patients.

From ‘strong recommendation’ to practice: A pre-test post-test study examining adherence to stroke guidelines for fever, hyperglycaemia, and swallowing (FeSS) management post-stroke

BackgroundThe Quality in Acute Stroke Care (QASC) Trial demonstrated that assistance to implement protocols to manage Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) post-stroke reduced death and disability. In 2017, a ‘Strong Recommendation’ for use of FeSS Protocols was included in the Australian Clinical Guidelines for Stroke Management. We aimed to: i) compare adherence to FeSS Protocols pre- and post-guideline inclusion; ii) determine if adherence varied with prior participation in a treatment arm of a FeSS Intervention study, or receiving treatment in a stroke unit; and compare findings with our previous studies. MethodsPre-test post-test study using Australian acute stroke service audit data comparing 2015/2017 (pre-guideline) versus 2019/2021 (post-guideline) adherence. Primary outcome was adherence to all six FeSS indicators (composite), with mixed-effects logistic regression adjusting for age, sex, stroke type and severity (ability to walk on admission), stroke unit care, hospital prior participation in a FeSS Intervention study, and correlation of outcomes within hospital. Additional analysis examined interaction effects. ResultsOverall, 112 hospitals contributed data to ≥1 one Audit cycle for both periods (pre=7011, post=7195 cases); 42 hospitals had participated in any treatment arm of a FeSS Intervention study. Adherence to FeSS Protocols post-guideline increased (pre: composite measure 35% vs post: composite measure 40 %, aOR:1.2 95 %CI: 1.2, 1.3). Prior participation in a FeSS Intervention study (aOR:1.6, 95 %CI: 1.2, 2.0) and stroke unit care (aOR 2.3, 95 %CI: 2.0, 2.5) were independently associated with greater adherence to FeSS Protocols. There was no change in adherence over time based on prior participation in a FeSS Intervention study (p = 0.93 interaction), or stroke unit care (p = 0.07 interaction). ConclusionsThere is evidence of improved adherence to FeSS Protocols following a ‘strong recommendation’ for their use in the Australian stroke guidelines. Change in adherence was similar independent of hospital prior participation in a FeSS Intervention study, or stroke unit care. However, maintenance of higher pre-guideline adherence for hospitals prior participation in a FeSS Intervention study suggests that research participation can facilitate greater guideline adherence; and confirms superior care received in stroke units. Nevertheless, less than half of Australian patients are being cared for according to the FeSS Protocols, providing impetus for additional strategies to increase uptake.

The effect of high-quality information technology on audit quality

Information Technology (IT) is changing the working environment and working process of clients and auditors. High-quality IT can enhance data accuracy, completeness and security, and automate data collection procedures. These attributes are important to auditors as their work highly relies on the quality of data. Using data from 2005 to 2013, this study provides empirical evidence showing that high-quality IT significantly enhances audit quality and reduces audit efforts. This study contributes to the stream of literature on IT quality and audit efficiency and can help managers understand how IT investments improve their data quality and audit quality.

Quality in Acute Stroke Care (QASC) Germany: improving efficiency in stroke care with nurse-initiated FeSS-protocols

BackgroundNurse-initiated supported implementation of protocols to manage fever, hyperglycaemia (sugar) and swallowing (FeSS) following acute stroke reduced 90-day death and disability in the landmark Australian Quality in Acute Stroke Care (QASC)-Trial. An international interprofessional collaboration sought to evaluate the effects of nurse-led FeSS implementation on FeSS Protocol adherence in German stroke units.MethodsThis pre-test/post-test study was conducted in eight German stroke units between 2020 and 2022. Stroke nurses as clinical champions, supported by the project team, conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support from Australia. Medical record audit data were collected by nurses, pre-implementation and three months post-implementation.ResultsIn 771 (pre-implementation) and 679 (post-implementation) patients there were improvements in overall FeSS adherence (pre 20%, post 28%; adjusted difference in proportions (95% CI) 11%, (5.1%, 16%); p < 0.001), adherence to hyperglycaemia (pre 43%, post 55%; adjusted difference 23%, (17%, 29%); p < 0.001) and swallowing (pre 52%, post 61%; adjusted difference 11%, (5.2%, 17%); p < 0.001) but not fever protocol (pre 76%, post 78%; adjusted difference 1.5%, (-2.6%, 5.7%); p = 0.474). Improvements also were noted in administration of anti-pyretics (pre 29%, post 59%; adjusted difference 32%, (20%, 44%); p < 0.001); and insulin (pre 41%, post 60%; adjusted difference 14%, (1.1%, 28%); p < 0.034) both within one hour, as well as in performing a swallow screen within 24 h of admission (pre 65%, post 74%; adjusted difference 18% (8.8%, 26%); p < 0.001).ConclusionsSupported implementation of the FeSS Protocols significantly improved acute care for post stroke complications of fever, hyperglycaemia and dysphagia in terms of higher adherence and shorter time to treatment.Trial registrationAs this is a pre-test/post-test study and does not meet the WHO/ICMJE definition of a clinical trial, registration was not required.

Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis Audit.

Background Prostate-Specific Antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision. Aim To estimate the proportion of prostate cancer cases diagnosed following asymptomatic PSA testing, and patient and practice factors influencing this route. Design and setting 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the national cancer registry, practice-level Quality Outcomes Framework (QOF), and General Practice Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included (n = 9,837). Method Patients with recorded biomarker testing and no recorded symptoms prior to diagnosis were classified as asymptomatic PSA detected prostate cancer. Patient (age, ethnicity, deprivation, co-morbidities) and GP practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed effects logistic regression models. Results 1,884 out of 9,837 (19%) prostate cancer cases were detected following asymptomatic PSA testing, 982 (52.1%) of whom were patients aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower co-morbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of asymptomatic PSA-detected cases, without clear explanatory GP practice-level factors. Conclusion One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between GP practices.

Study on Audit Risk Model Based on Data Mining Algorithm

With the widespread application of modern information technologies such as big data, enterprises have generated a large amount of data in their daily operations. The traditional audit methods have drawbacks such as high cost and high consumption, and can no longer meet the needs of audit work in the digital era. Therefore, it is urgent to adopt audit methods suitable for the digital era to improve audit quality and reduce enterprise Audit risk. For professional auditors in enterprises, it is very important to utilize emerging technologies such as data mining algorithms. The audited enterprise may tamper with its financial statements, and identifying high-quality audit data from massive amounts of data is a huge challenge. Compared to traditional audit methods, data mining algorithms can significantly improve the efficiency and accuracy of audit work. For example, the BP neural network, with its powerful nonlinear mapping ability, can capture complex relationships in data; Support vector machines classify data by finding the optimal hyperplane in high-dimensional space and have good generalization ability; random forest reduces overfitting and improves prediction accuracy by integrating multiple decision trees; Association rule algorithms can discover interesting relationships between data items, helping auditors identify potential fraudulent behavior or abnormal transactions. Therefore, the purpose of this study is to accurately evaluate and reduce the audit risk of enterprises, and to build an audit risk model using computer data mining algorithms. This provides necessary reference and guidance for auditors to conduct data analysis and mine valuable data during the audit process of enterprises, thereby improving audit efficiency.

Equity-Focused Evaluation of a Medicaid-Funded Statewide Diabetes Quality Improvement Project Collaborative.

To evaluate the Ohio Diabetes Quality Improvement Project (QIP) equity aim to reduce the percentage of Non-Hispanic Black (NHB) and Hispanic patients with A1C >9% by ≥20% over 2 years. The Ohio Department of Medicaid, Ohio Colleges of Medicine Government Resource Center, Ohio Medicaid managed care plans, and seven medical schools in Ohio formed the Diabetes QIP collaborative using the collective impact model to improve diabetes outcomes and equity in 20 practices across 11 health systems. The quality improvement (QI) strategies included data audit and feedback, peer-to-peer learning, QI coaching/practice facilitation, and subject matter expert consultation through coaching calls, monthly webinars, and annual virtual learning sessions. Electronic health record data were collected for preintervention (2019-2020) and intervention (2020-2022) periods. Assessments of improvements in A1C were based on prevalence of A1C >9% from preintervention, year 1, and year 2 with stratification by race and ethnicity. The Diabetes QIP included 7,689 (54% female) sociodemographically diverse patients, self-identifying as non-Hispanic White (NHW) (42%), NHB (43%), Hispanic (8%), non-Hispanic Asian (4%), or other (3%). In year 2 compared with baseline, there were decreases in the proportion of patients with A1C >9% among NHW, NHB, and Hispanic patients (NHW from 19% to 12% [37% reduction], NHB 23% to 18% [22% reduction], and Hispanic 29% to 23% [20% reduction]). The Ohio Diabetes QIP, focused on multisector collaborative approaches, reduced the percentage of patients with A1C >9% by ≥20% among NHW, NHB, and Hispanic populations. Given the persistence of disparities, further equity-focused refinements are warranted to address disparities in diabetes control.

Improving the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust

BackgroundCultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital...

Enhancing care coordination through transitional care management.

232 Background: West Cancer Center and Research Institute (WCCRI) serves Memphis and the Arkansas, Mississippi, and Tennessee tri-state region as the comprehensive care leader in adult cancer care and research, amounting to over 260,000 visits across 57,000 unique patients in 2023. Cancer patients are predisposed for higher risk of hospital admissions, making uniform care coordination between the discharging hospital and their outpatient oncology care home essential to care continuity. While WCCRI attempted to mitigate readmissions, there was no formalized managed care approach for capturing and responding to unplanned patient hospital visits to prevent readmission. Auditing of claims data suggested nearly 500 patient care opportunities within a four-month period. Methods: To improve continuity of care and decrease preventable readmissions, WCCRI implemented a care transitions process based on the Centers for Medicare and Medicaid's Transitional Care Management (TCM). This required a repeatable approach of proactive outreach to patient upon discharge, a clinical assessment of patient need, and an office visit within fourteen days of discharge. To maximize impact, this project was scoped to patients with unplanned hospital admissions who are at moderate to high risk for readmission. Results: Twelve months after implementation, WCCRI has proactively identified 974 patients qualifying for TCM and successfully scheduled 91.48% for a hospital follow-up appointment with their oncologist. Proactive outreach to patients has led to a 35% increase in office visits within fourteen days of discharge, a key measure of care continuity. Conclusions: Learnings from this implementation project have been spread to formalize hospital follow-up approaches across WCCRI. By aligning policies, engaging stakeholders, and fostering a culture of collaboration and accountability, WCCRI has delivered high-quality, coordinated care, and achieved better patient outcomes.

Comparative outcomes of selective laser trabeculoplasty delivered by optometrists compared with ophthalmologists: a UK-based multicentre observational study

BackgroundSelective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational...

Neighborhood demographics in relation to marketing and regulation-related factors among cannabis retailers in 5 US cities

ObjectivesThis study assessed differences in cannabis retailer practices by neighborhood sociodemographics, which can inform disparity-relevant interventions. MethodsMultilevel multivariable logistic regressions examined retailers’ census tract demographics (percent <21 years-old; non-Hispanic White, Black, or other race, Hispanic; median household income [MHHI]) in relation to 2022 audit data regarding marketing (youth-oriented signs, health-claims, exterior ads, price specials, membership programs, delivery/pick-up) and regulatory compliance (pregnancy and health-risk warning signage, exterior minimum-age signage) among 150 randomly-selected retailers in 5 US cities/states (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Results20.7% had youth-oriented signage, 28.7% health-claim signage, 27.3% exterior ads, 75.3% price specials, 39.3% membership programs, 28.0% delivery/pick-up, 72.0% pregnancy warnings, 38.0% health-risk warnings, and 64.0% minimum-age signage. Retailers in tracts with higher percent <21 and non-Hispanic White had lower odds of youth-oriented signage. Higher MHHI had higher odds of health-claims; higher percent Hispanic had lower odds of health-claims. Higher MHHI had lower odds of exterior ads. Higher percent <21 had lower odds of price specials. Higher percent non-Hispanic White had higher odds of membership programs. Higher percent non-Hispanic White, other race, and Hispanic had higher odds of delivery/pick-up; higher MHHI had lower odds of delivery/pick-up. Higher percent non-Hispanic White had higher odds of pregnancy warnings. Higher percent <21 had lowers odds of health-risk warnings. Demographics were unrelated to minimum-age signage. ConclusionsGiven key findings (e.g., lower compliance in racial/ethnic minority communities), cannabis retail could exacerbate disparities, underscoring the need for related regulatory and prevention efforts.

Influences of Specialist Palliative Care Team Input, Advance Care Planning, Non-Invasive Ventilation and Gastrostomy Status on Unscheduled Hospital Admissions and Place of Death for People with Motor Neuron Disease: A Retrospective Cohort Analysis.

Motor neuron disease is a rapidly progressing neurological condition. People with life-limiting conditions generally prefer to die at home and avoid hospital admissions, with Specialist Palliative Care Team involvement often pivotal. Our aim was to investigate the role of advance care planning, Specialist Palliative Care Team input and other relevant variables on place of death and unscheduled hospital admissions in a Scottish population of people with motor neuron disease. Methods: National CARE-MND audit data, primary and secondary care data, and local Palliative Care records were interrogated. Chi-square, point-biserial correlation and binary logistic regression analysed associations (p < 0.05 statistically significant). Participants (188) were deceased, having a verified motor neuron disease diagnosis between 2015-2017, diagnosis occurring ≥28 days before death. Results: Advance care planning and Specialist Palliative Care Team input of ≥28 days were associated with increased odds of dying outside hospital (BLR:OR 3.937, CI 1.558-9.948, p = 0.004 and OR 2.657, CI 1.135-6.222, p = 0.024 respectively). Non-invasive ventilation decreased the odds of dying outside hospital (BLR:OR 0.311, CI 0.124-0.781, p = 0.013). Having a gastrostomy increased odds of ≥1 admissions in the last year of life (BLR:OR 5.142, CI 1.715-15.417, p = 0.003). Statistical significance was retained with removal of gastrostomy-related complications. Conclusion: Early Specialist Palliative Care input and advance care planning may increase the likelihood of death outside of hospital for persons with motor neuron disease. Further research is warranted into barriers of facilitating death outside of hospital with home non-invasive ventilation use and the association between gastrostomy status and unscheduled admissions.