Final Audit Research Articles

Analisis Flypaper Effect Pada Pemerintah Daerah Di Provinsi Papua

The purpose of this research is to analyze the effect of General Allocation Fund Transfer (DAU) and Local Income (PAD) to local government expenditure (BD) in Papua Province. To determine and analyze how flypaper effect happen to the local government expenditure in Papua Province. This research using panel data in the 26 (twenty six) out of 29 local government in Papua Province in the year of 2010-2013 period. The data gathered from the Regency Expenditure Realization Report on the Fund report of local government that already get into final audit from BPK RI and submitted to the DJPK Ministry of Finance of The Republic of Indonesia and Papua in Figures that published by Central Bureau Of Statistics. This research results show that PAD and DAU at the same time positively affect the local government expenditure (BD) in Papua Province; but only DAU coefficient affects significantly and having a positive relation to the regency expenditure, while PAD statisticaly not significant to the local government expenditure in Papua Province. Coefficient value of DAU is higher than the PAD even though only the DAU is signifficant, this thing shows flypaper effect has detected happen on the local government expenditure in Papua Province.Keywords: Flypaper Effect, General Allocation Fund, DAU, PAD.

OVERLAPPING FOR LAND OWNERSHIP RIGHTS: ALTERNATIVE DISPUTE RESOLUTION BY OMBUDSMAN

The research aims to find out the implementation of the function of ombudsman in resolving overlapping disputes for land ownership rights. It is a socio-juridical research, a combination of normative and empirical research. It was conducted in Tanjung Selor subdistrict, Bulungan district, North Kalimantan. The results of research indicated that the overlapping of land rights was caused by the consequent non-enactment of the law, unclear land boundaries, the ease of making Land Ownership Statement, and development. The measures that have been taken by the Ombudsman of North Kalimantan are written clarifications, field investigations, summons, issuance of the final audit report, and monitoring. Therefore, in resolving the overlapping dispute based on these rights, the ombudsman does not undertake a litigation or non-litigation resolution because the final product of the resolution made by the ombudsman is only a recommendation, and now the case of overlapping land rights has only just at monitoring stage. For this reason, an active role from the government is needed to conduct socialization related to land registration, so that the government community will always work together to keep land registration data up to date.

CAR-T therapy: the role of the hematopoietic stem cell processing laboratory

Objectives: Purpose of this paper is to review all the phases that involved, for the first time, the SC of Hematology and the SC of Transfusion Medicine, specifically, the CSE Processing laboratory, in implementing an innovative operative protocol of gene immunotherapy due to the inclusion of the first patient, affected by diffuse large B-cell lymphoma (DLBCL), stage IV, into the CAR-T therapeutic program. The program took place within the SS Antonio e Biagio e Cesare Arrigo Hospital of Alessandria.Methods: Firstly, lymphocytes are taken from the patient through a technique called lymphocytoapheresis and inserted into a blood bag. The blood bag is sent to the CSE Processing laboratory, where, after sampling, the following steps are carried out: cell manipulation, possible cryopreservation of the product and subsequent dispatch to specialized production centers, called: Cell Factory. In this laboratory, lymphocytes will be genetically manipulated to be able to express the CAR receptor and co-stimulating factors and, finally, expanded. After 4 weeks, the engineered lymphocytes will return as drug to the CSE Processing laboratory to be reinfused to the patient.Results: At the end of the operative procedure a report is compiled. The report is issued by the laboratory and contains all the information of interest to the clinician.Conclusions: The purpose of my annual experience as a graduate student was to describe the role of the CSE Processing laboratory within the drug production chain. Being experimental and extremely innovative, T-cell-based gene therapy cannot be considered a routine practice. The centers authorized to administer the CAR-T are identified by the Regions and must possess specific organizational and infrastructural requirements. Even the manufacturers of CAR-T therapies have a qualification path that involves inspection by the company's monitors and a final audit. The Processing laboratory, together with the Apheretic collection laboratory, Pharmacy and Hematology, obtained the qualification of "European site Qualified for KYMRIAH® (tisagenlecleucel) and YESCARTA® (axicabtagene ciloleucel)" in 2021.

Commentary on the harm reduction reference group of justice health and forensic mental health network and corrective services NSW, Australia.

This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee's success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group's audit were drawn by critically appraising the JHFMHN/CSNSW HRRG's Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.

196 A QUALITY IMPROVEMENT INITIATIVE TO OPTIMISE PHYSIOTHERAPY FALLS ASSESSMENT AND INTERVENTION

Abstract Background Falls are the most commonly reported incident in the Health Service Executive (HSE 2018). Our aim was to implement the standard: every patient referred to physiotherapy over 65 years or at risk of falls received a personalised falls assessment and intervention. Methods Falls assessment and intervention standards were captured through documentation audit in November 2020. Representatives from all physiotherapy specialties were invited to join the physiotherapy falls committee. The falls committee met monthly to review tests of change, discuss audit results and plan further initiatives. A ‘Falls Algorithm’ was developed outlining expectations regarding falls, with three components: ‘Ask, Assess, Intervene’. In-service training on falls was organised and added to induction for staff-grade rotations. Falls champions were identified in each area to promote best practice and induct new staff to expected standards. A falls newsletter was added to the department weekly bulletin to keep a focus on falls. Physiotherapy assessment forms on the electronic patient record were updated, embedding falls assessment and intervention into routine practice. A falls prevention and exercise booklet was developed and the falls education talk was transferred to an online format with Occupational Therapy colleagues. Audits across all areas were completed weekly, then monthly to track results. The most recent audit was carried out in May 2021. Results Falls assessment improved from 57% to 99%. Fear of falling assessment improved from 30% to 88%. Completion of falls outcome measures improved from 26% to 74%. Falls intervention increased from 49% to 100%. Gait/balance deficits were assessed in 94% of cases in the final audit. Conclusion The aim that all patients referred to physiotherapy over 65 years or at risk of falls receive a personalised physiotherapy falls assessment and intervention was achieved.

Compliance to kangaroo mother care best practice: an evidence-based implementation project.

Worldwide about 13 million babies are born prematurely every year. Kangaroo mother care (KMC) is a proven, acceptable and feasible method to decrease the mortality rate of premature infants. Reviewing current KMC practices, implementing in the context and auditing the compliance would benefit the promotion evidence-based practice (EBP), which was not well known in the study area. The main objective of the study was to increase awareness of EBP for KMC in the neonatal care unit of a public hospital through identifying local barriers and facilitators, and to measure compliance with best practice recommendations. The current KMC best practice quality improvement project was conducted between March and May 2018. The project team was established for this implementation project. Six KMC best practice audit criteria were used to evaluate the compliance at baseline and endline using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. All (20) clinical staff who were working in the neonatal care unit were included in the study. Based on the baseline audit result, gaps and barriers were identified and discussed, and implementation strategies specific to the local setting were developed to mitigate the gaps. Baseline results were compared with the final follow-up audit result to measure change in compliance. Again, these data were compared with other studies to identify the sustainability of the project in a clinical setting. A total of 80 cases (baseline 20 and implementation 60) were observed demonstrating KMC procedures. Study found that follow-up compliance rates for all criteria improved compared with baseline audit; for example, criterion 5 (assessment of infant's condition) improved from 20% during baseline to 90% during follow-up and criterion 3 (parent/family received counselling) improved from 30 to 95%. The current study demonstrated that EBP training and frequent supportive supervision translated in improved compliance to best available evidence to KMC in a resource-limited setting.

Counting ECGs in acute psychiatry – The patients' price for junior doctors' rotations

AimsOn 05/08/20, when a new cohort of doctors rotated onto an acute ward, (John Dickson Ward, Maudsley Hospital, London) a new handover tool on MS Teams was introduced, which replaced previously used MS Word document. The new handover tool can be accessed and edited by any of the users in the team. We hypothesised that the introduction of an interactive, live-updated tool would help improve physical health monitoring for patients, especially compliance with ECG taking. The aim of this project was to test this hypothesis.MethodAuthors have reviewed electronic documentation of patients admitted to and discharged from John Dickson Ward between 01/04/2020 and 24/12/2020. Evidence of whether an ECG was performed, was offered but declined by the patient, or was not offered were noted in the final audit. Patients were divided into 3 groups: (1) Patients admitted and discharged from 01/04/20 – 05/08/2020; (2) Patients admitted and discharged from 05/08/2020 – 24/12/20, and (3) Patients admitted before the intervention date, but discharged after the date (i.e., the period when new junior doctors had rotated onto the ward). Fifty patient records were identified in Group 1, fifty in Group 2, and 18 in Group 3.ResultSurprisingly, the percentage of patients who had a documented ECG did not improve after the intervention, with 37/50 (74%) of patients having an ECG in Group 1, and 37/50 (74%) of patients having an ECG in Group 2. However, an incidental finding was made that significantly fewer patients received ECGs during the changeover period (Group 3), with only 6/18 (33%) of patients receiving ECGs. The percentage of patients who were not offered ECGs also increased during the changeover period, with 2/50 (4%) in Group 1, and 3/18 (17%) in Group 3 not being offered.ConclusionThis incidental finding highlights the challenges associated with the junior doctor changeover period. Much time is needed for doctors to adjust to their new surroundings and methods of working, and this may result in basic elements of patient care being overlooked. We surmise that other elements, such as ensuring all patients having regular blood tests and physical examinations, may also be of a lower standard during this period. There is scope for future audits to address this, and for future quality improvement projects to implement changes ensuring medical care remains at a high standard during junior doctor changeover periods.

The Covid 19 pandemic as a factor of compliance with the rules of hand hygiene of hospital staff

Introduction. Hand cleansing and disinfection is the most effi- cient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational pro- gram titled “Clean Care is a Safer Care”. The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accu- racy of hand decontamination by medical personnel. Objective. The objective of the study was to assess the useful- ness of the educational program titled “Clean Care is a Safer Care” as a tool for increasing compliance with hand hygiene principles. Methods. We monitored the compliance with the hygiene proce- dure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. Results. In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospi- tal increased to 435/500 points. Conclusions. COVID-19 pandemic dramatically increased accu- racy of proper hand hygiene procedures and consumption of dis- infectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.

Reflextherapy in Healthcare – Reflection on Audit Result and Employment of Therapy

An article was published in 20141 reporting on an audit of the Membership of the Association of Chartered Physiotherapists in Reflextherapy (ACPIRT). This article reflects on the outcome of the audit in the context of a treatment tool in physiotherapy and allied health professions in the United Kingdom and abroad. Background: ACPIRT was established in 1992 by Christine Jones, physiotherapist, and associated colleagues to provide a clinical interest group for physiotherapists and allied health professionals practising reflextherapy (RT), a manual therapy applied to the feet (or hands) similar and akin to reflexology. The audit was carried out in 2009 to establish a professional profile of members and to document their clinical experiences in using RT in healthcare. Methodology: 161 ACPIRT members were sent a postal questionnaire (including a stamped return envelope) regarding their experience using RT treating patients in the NHS and/or in private practice. One hundred (62%) members responded. A pilot study was carried out prior to the main enquiry including 14 ACPIRT committee members. Their results were included in the final audit result. Aims: i) To describe members’ demographics, work environments and opinions of the value of RT in healthcare. ii) To describe the historical background and development of RT to become an accepted therapeutic intervention by the Chartered Society of Physiotherapy. Results: Sixty-eight respondents (68%) considered RT ‘very good’, ‘good’ and ‘as good as’ orthodox physiotherapy. Fifty-eight respondents (58%) thought RT had a 25% placebo effect. No one considered RT to have a 100% placebo effect. Overwhelmingly, 95 respondents (95%) reported ‘relaxation’, ‘reduced stress’ and ‘reduced pain’ as main benefits of the treatment. A few respondents reported ‘increased fertility’, ‘improved bowel function’ and ‘reduced appetite’. Comments were made on the future of RT and recommendation for a Foundation Course. The results showed a mature, highly experienced professional membership with a female gender bias.

Remote Mentorship Using Video Conferencing as an Effective Tool to Strengthen Laboratory Quality Management in Clinical Laboratories: Lessons From Cambodia.

Providing professional development opportunities to staff working in clinical laboratories undergoing quality improvement programs can be challenged by limited funding, particularly in resource-limited countries such as Cambodia. Using innovative approaches such as video conferencing can connect mentors with practitioners regardless of location. This study describes and evaluates the methods, outputs, and outcomes of a quality improvement program implemented in 12 public hospital laboratories in Cambodia between January 2018 and April 2019. The program used mixed intervention methods including both in-person and remote-access training and mentorship. Training outputs were quantified from the activity reports of program trainers and mentors. Program outcomes were measured by pre- and postimplementation audits of laboratory quality management system conformity to international standards. Variations in improved outcomes were assessed in relation to the time spent by laboratory personnel in video conference training and mentoring activity. An additional cross-sectional comparison described the difference in final audit scores between participating and nonparticipating laboratories. Laboratories significantly improved their audit scores over the project period, showing significant improvement in all sections of the ISO 15189 standard. Pre- and postaudit score differences and laboratory personnel participation time in remote mentoring activities showed a strong monotonic relationship. Average input per laboratory was 6,027±2,454 minutes of participation in video conference activities with mentors. Audit scores of participating laboratories were significantly higher than those of laboratories with no quality improvement program. Laboratories improved significantly in ISO 15189 conformity following structured laboratory quality management systems training supported by remote and on-site mentoring. The correlation of laboratory participation in video conference activities highlights the utility of remote video conferencing technology to strengthen laboratories in resource-limited settings and to build communities of practice to address quality improvement issues in health care. These findings are particularly relevant in light of the COVID-19 pandemic.

Screening for expired medications in automated dispensing cabinets

Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported. A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention. At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer-only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket. Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets.

Audit of electronic operative documentation in interventional radiology: the value of standardised proformas

BackgroundOn the background of the interventional radiology department of a tertiary hospital converting its periprocedural documentation from paper-based to electronic using a standardised proforma, a study was performed to ascertain the effects of this change on the standard of clinical documentation for radiologically-guided angiographic procedures. Using a retrospective approach, perioperative records were analysed in reverse chronological order for inclusion in the study. The standard for this audit was developed in the form of minimum criteria that all clinical documentation of angiographic procedures were expected to meet.ResultsThe audit was performed at three equally spaced intervals of 6 months, yielding a total of 99 records. The baseline audit of paper-based records concluded > 80% completeness for 8 out of the 14 of parameters measured, with only two of parameters meeting the target of 100% completeness. The second audit cycle performed on electronic records found 7 out of 14 parameters demonstrating absolute improvement in completeness, when compared to paper-based, but with the number of parameters exceeding 80% completeness falling to only 4 out of 14. Again, 100% completeness was observed in only 2 of the parameters. In the final audit cycle, after the introduction of a standardised electronic proforma, performance improved in every dimension with 6 out of 14 parameters reaching completeness of 100% and the 80% completeness threshold met by 12 out of 14 parameters.ConclusionThe construction of a procedure-specific perioperative electronic proforma can save clinicians valuable time and encourage safe and effective clinical documentation.

Evidence of the Financial Audit

Evidence is an argument that justifies the truth or falsity of a subjective opinion or assertion. Characteristics of audit evidence directly impact the obtaining process of sufficient audit evidence as well as determine the final audit decision regarding fairness and truthfulness of financial reporting. The purpose of the article is to identify the material aspects of evaluating audit evidence and to define the concept of the financial statement‘s audit evidence. The research methods applied in the article are comparative analysis and synthesis of Lithuanian and foreign scientific literature, interpretation, critical thinking and systematization of financial audit laws and regulations. Furthermore, the article examines the concept of financial audit evidence, its characteristics and criteria of reliability as well as disclosure of material audit evidence.

JUDGEMENT STATE AUDITOR ON AUDIT OPINION FOR GOVERNMENT FINANCIAL STATEMENT WITH PERSPECTIVE HERMENEUTIC PHENOMENOLOGY

Background. The Audit Act no 15, 2004 stated that audit opinion is based on 4 (four) criterias, which are accounting standard, compliance on law and regulation, effectivity internal control system and full disclosure. Public accountability quality of financial statement that audited by BPK RI should be based on State Finance Audit Standard (SPKN) and audit system or guidelines to attest the truth and fairness of the judgement. State finance auditor will make audit judgement for audit opinion based on all material of financial statement, not only in quantitative but also qualitative manner of significance financial information as part of public accountability. However, audit process is not only depends on structured standard system approach but also influenced by individual (auditor) subjectivity. Auditor subjectivity is difficult to be avoided during the audit process and may play a role in the audit judgement and final audit opinion.Objective. Our study aims to analyze the role of BPK RI auditor subjectivity during audit judgement in government institution and in making final audit opinion, using interpretive hermeneutic phenomenology.Methods. Our study analyzed audit judgement with interpretive process hermeneutic and phenomenology perspective.Results. We conducted in-depth interviews with BPK audit opinion signing auditors and analyzed how auditor interpreted audit data, in regards with the basic principles of public accountability, audit standard, law and regulation, internal control and complexity organization in the auditee institution. Our study found differences among auditors in interpreting audit data based on different perspective and understanding of standard system, law and regulation and complexity of organization, mostly because they did not use basic principles of public accountability during the process and making audit judgement and final audit opinion.Conclusion. Our results came to understanding that auditors should be using basic principles of public accountability when interpreting audit data, audit standard, law and regulation to improve quality of audit judgement. Auditors of BPK as supreme audit institution in Indonesia should combine all aspects in auditing process and making final audit judgment.Key words : Audit Opinion, Public Accountability, Audit Judgement, Hermeneutic Phenomenology.

Translation and cognitive testing of the Italian Integrated Palliative Outcome Scale (IPOS) among patients and healthcare professionals.

BackgroundOutcome measurement is fundamental to assess needs and priority of care in palliative care settings. The Integrated Palliative care Outcome Scale (IPOS) was developed from earlier versions of this tool. Its use is encouraged to ameliorate the assessment of individual outcomes in palliative care settings. This study aimed to translate and culturally adapt IPOS into Italian, and explore its face and content validity.MethodsAfter forward-backward translation, a qualitative study explored the views of and cognitive processes used by respondents. We conducted individual semi structured interviews with 21 patients admitted to two palliative care services, from hospitals, hospices and the community, and focus groups with 12 professionals working in multidisciplinary palliative care teams and used thematic analysis. The results were integrated in a final audit, including the project team and the original POS developers, to refine the final format of the tool.ResultsWe conducted 21 face to face cognitive interviews with patients, and 2 focus groups with 14 professionals. Patients and professionals felt content and format of IPOS appropriate and feasible, and not burdensome. Some layout problems were raised leading to adaptation. Main issues regarded: clarifying the meaning of choices and some cultural interpretation of some questions and response options and interpretation of some instructions. We proposed using some new terms as more appropriate and comprehensive in our context, such as replacing the term “family” with “dear ones”. The items that appeared unchanged from the previously validated Italian POS were left unmodified to maintain coherence.ConclusionsThe Italian IPOS, in its four versions directed to patients or staff and with a recall period of 3 or 7 days, has face and content validity for use in clinical settings and is ready for further psychometric and clinimetric validation.

Can Medical Students Lead Effective Quality Improvement Initiatives? A Systematic Review.

Quality improvement project (QUIP) concepts are becoming embedded into medical school curricula, with many students now expected to conduct a QUIP as part of their progression. This study aimed to assess whether student-led QUIPs can be effective and sustainable. A systematic literature search was conducted using 5 databases: MEDLINE, Embase, Ovid, CINAHL, and PsycINFO. The authors searched for articles published between January 28, 1978, and January 28, 2018. In all, 3965 articles were identified through database searching, and an additional 9 articles through hand searches. After screening and full-text analysis, 12 articles were included. Greater than 50% of QUIPs described a statistically significant improvement in the primary outcome. However, effective student-led QUIPs were not necessarily sustainable, with a mean final audit at 4.4 months. Medical students have the potential to produce effective QUIPs. There now needs to be a structured approach to give medical students the freedom to test and validate more unique interventions.

Nursing and medical contribution to Defence Healthcare Engagement: initial experiences of the UK Defence Medical Services

IntroductionThe WHO Constitution enshrines ‘…the highest attainable standard of health as a fundamental right of every human being.’ Strengthening delivery of health services confers benefits to individuals, families and communities,...

Practical implementation of the PIC/S principles in Ukraine after its accepting international requirements for quality control of medicinal products

Pharmaceutical Inspection Cooperation Scheme (PIC/S) is an international instrument of interaction between countries and regulatory authorities in the sphere of quality control of medicines (by national pharmaceutical inspectorates), which together provide an active and constructive cooperation in the field of good manufacturing practices (GMP), inspection and licensing. Aim. To develop a strategy, tactics and sequence of applying adaptation mechanisms to the pharmaceutical industry legislation of Ukraine according to EU and the PIC/S requirements. Results. In 2010, within Ukraine joining to the PIC/S the starting audit of researches on adaptation of medicinal products quality standards to the international requirements was carried out. In the period from March 22 to 26, 2010 the PIC/S audit team performed the final audit in order to check the readiness of Ukraine to join the PIC/S. On November 8,2010 a decision on Ukraine’s membership was made in Kuala Lumpur (Malaysia). Since January1, 2011 Ukraine has become the PIC/S member within the system of medicinal products circulation and quality control in accordance with GMP/GDP and EU Directive 2001/83/EC. During the period of Ukraine’s accession to the PIC/S system, accordingly, this Directive was improved. At the VIII National pharmaceutical Congress (Kharkiv, September 14-16, 2016) 26 additions to the decision of Congress were proposed, including questions related to the PIC/S and other legislative initiatives. Conclusions. Legislative documents of the system of medicines quality control and circulation inspection are the international requirements of the PIC/S. The principles, measures and requirements were developed, discussed and accepted that contributed to the accession of Ukraine to the PIC/S system in 2011.

The use of audit in the diagnosis of oral leishmaniasis

Background: Oral Leishmaniasis is a new diagnostic challenge both globally and nationally. Once thought to be a part of mucocutaneous Leishmaniasis, oral Leishmaniasis can be defined as a distinct form of Leishmaniasis. It is yet to be included as an important and distinct differential diagnosis of ulcerative, ulceroproliferative and granulomatous disorders. It currently poses a diagnostic challenge for the dental practitioner where it is both misunderstood and confused with other diseases. If there is delayed treatment, it can cause severe disfigurement and other difficulties. This study utilises the benefits of audit systems in understanding and/or modifying an undesired trend within a medical departmental environment. We present the audit: ‘’Oral Leishmaniasis identification audit’’ in an attempt to improve the early diagnosis of oral Leishmaniasis by dental practitioners at National Ribat University Hospital. Materials and methods: Three hundred questionnaires were distributed of which 267 were returned. These included undergraduate students (90), postgraduate students (37) and junior and senior dental practitioners (140). The 1st audit included 53 (27 males, 26 females) patients. Intervention was executed between the 1st and 2nd audit cycle to improve standards which consisted of a 3 months’ educational period. Thirty-four (17 males, 17 females) patients were included in the 2nd audit cycle. A review of change and recommendations for future improvements was undertaken. Results: Pre- audit questionnaires returned by dental practitioners (140/267) in particular highlighted both poor undergraduate and postgraduate training standards for oral Leishmaniasis. Seventy- three percent of dental practitioners (102/140) had not learnt of oral Leishmaniasis previously or its oral manifestations. There was a significant improvement in the early diagnosis of oral Leishmaniasis between the 1st and 2nd audit cycles (P value < 0.05). The final audit cycle results showed a 33% rise in the early identification of oral Leishmaniasis. Conclusion: The early identification of oral Leishmaniasis was significantly improved after the use of audit. Sixty-five percent of patients were diagnosed within 3 months of initial presentation in the 2nd audit compared to 32% in the 1st audit. Audit planning and implementation is a useful component in achieving optimum clinical standards. It has succeeded in improving the early diagnosis of oral Leishmaniasis at National Ribat University Hospital. Both practitioners and patients were upgraded in knowledge regarding Leishmaniasis in general and oral Leishmaniasis specifically in terms of diagnosis, prevention of spread and contraction and treatment.

Addressing Opioid-Associated Constipation Using Quality Oncology Practice Initiative Scores and Plan-Do-Study-Act Cycles.

Using the Quality Oncology Practice Initiative, an affiliate program of ASCO, we outlined opioid-associated constipation (OAC) as a subject in need of quality improvement (QI) in our fellowship program at the University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System. We initiated a fellow-led QI project to advance the quality of patient care and provide a valuable avenue for QI training of young physicians. Fellows organized meetings with all stakeholders, addressed the scope of the problem, and devised strategies for OAC management. Monthly meetings were organized using Plan-Do-Study-Act principles. Mandatory check boxes were inserted into our electronic medical record templates to remind all physicians to identify patients on opioid medications and assess and address OAC. Final chart audit and patient satisfaction surveys were performed 6 months after project initiation. Assessment of OAC improved from 52% at baseline to 92% ( P < .003). This improvement corresponded with high patient satisfaction scores, with 90% of surveyed patients reporting adequate management of their constipation. In this QI initiative, we showed that participation in ASCO's Quality Oncology Practice Initiative helps identify areas in need of QI, and such fellow-led QI projects can serve as models for QI training of young physicians.