Online Audit Research Articles

Discrimination Against Puerto Ricans in the Puerto Rican Housing Market: Evidence From a Preregistered Audit Experiment

Abstract Do locals discriminate against themselves by favoring foreigners with higher expected purchasing power? Drawing on theories of prejudice, discrimination, and colonialism, I argue that in colonized and post-colonial countries, local home sellers discriminate against local potential homebuyers while favoring foreigners with expected higher purchasing power, anticipating a more profitable transaction. I support this argument with evidence from a preregistered online audit study targeting discriminatory attitudes toward local home buyers. In the study, fictitious home buyers with distinctive language and ethnic names emailed 1,512 home sellers (realtors and homeowners) across all municipalities in Puerto Rico. Home sellers reported more houses available to Americans and invited them to more house showings than Puerto Ricans. My estimates indicate that ethnic discrimination exists in the Puerto Rican housing market. These findings provide new insights into ethnic dynamics in colonized and post-colonial societies and underscore concerns about recent legislation that turned Puerto Rico into a tax haven.

A validation study for measuring Asian- and Hispanic-serving sociocultural institutions in neighborhoods using business listing data and potential implications for health

Ethnic enclaves influence the health of Asian American and Hispanic or Latinx/a/o populations, likely via neighborhood social, economic, and built environments. To facilitate studies aiming to disentangle these specific neighborhood mechanisms, we describe the creation and validation of two novel measures—Asian-serving and Hispanic-serving sociocultural institutions (SCIs)—to estimate the social, cultural, and economic character of ethnic enclaves in California. Business listing data were used to identify SCIs or businesses that promote cultural and social identity, including arts, civic, historical, religious, social service, and membership organizations. Keyword searches of business names were used to identify potential Asian- or Hispanic-serving SCIs. An online audit of 1,627 businesses within 12 cities confirmed the validity of using keyword searches to assess whether census tracts were high or low in Asian- or Hispanic-serving SCIs (sensitivity: 63%–100%, specificity: 86%–95%; positive predictive value: 63%–89%). In exploratory regression analyses, high presence of SCIs (compared to low presence) may be associated with neighborhood-level health indicators, including greater percentages of residents who had an annual checkup in majority Asian census tracts and lower percentages of residents who were current smokers in majority Asian and Hispanic census tracts. This approach advances methodology in measurement of neighborhood sociocultural environments.

Healthy, family-friendly apartment kitchen design: a study of practice in Melbourne, Australia

This study explored constraints and opportunities in apartment kitchen design for family home cooking and dining. An online audit of 115 two-bedroom apartments in three Melbourne suburbs of Australia was conducted, with images collected from the audit guiding photo-elicitation interviews on the kitchen designs, with architects from firms involved in apartment complex design. Affordance theory provided a conceptual lens to thematically analyse the design process and outcome in relation to architectural practice. Based on previously developed criteria, results from the audit revealed that only 18 (16%) had adequate kitchen design for families with children across five features assessed, with four themes emerging from interviews that identified constraints and facilitators to kitchen design practice: “Limited policy standards”; Architect assumptions align with market-led preferences”; “Built environment and apartment typology constraints”; and “Small scale design opportunities”. Findings provide unique insights into architects’ perspectives on apartment design, deepening understandings of how to support healthy family home food preparation and dining.

ДІЯЛЬНІСТЬ АУДИТОРСЬКИХ ФІРМ В УМОВАХ ВОЄННОГО СТАНУ – ОНЛАЙН-АУДИТИ

The issue of audit development under martial law and post-war reconstruction is currently extremely relevant and plays an important role for both business and the state, which influenced the choice of the topic, stated goal, objectives, subject and structure of the research. As a result of the hostilities and mass migration, the audit industry has suffered serious negative consequences. The legislator has taken significant measures to stabilize the situation and restore the activities of audit entities. A whole range of regulations was adopted to ensure the effective operation of audit firms. In particular, scholars have paid great attention to the issue of online audits. Prominent international organizations of auditors and professional accountants have developed the Guidelines for Ukrainian auditors taking into account the conditions of the military conflict. It turned out to be urgent because business entities that continue to operate in the conflict zone need constant support and advice. The article analyzes the state of audit activity in the context of the military conflict, identifies the main problems and suggests the ways to solve them. The authors also identified the main directions of development of audit entities with a view to achieving European integration, including their regulatory framework. The general scientific and general theoretical methods were used in the work: system analysis - to determine the main research criteria; abstract and logical - to make theoretical generalizations and conclusions about the problems and challenges of audit activity in war conditions; induction - at the stage of collecting, systematizing and processing information for research; deduction - in the process of studying the theoretical problem. The article analyzes the current state and prospects of audit activity and online audit in the context of modern business. The main problems faced by auditors are considered, and the main challenges facing audit firms are identified. Among other things, the positive aspects and future opportunities of online audit were highlighted, and the services that can be provided through this form of audit were considered. The authors found that the issues related to audit activity under martial law were regulated at the legislative level, and the main areas of support for auditors in the post-war period were identified. Prospects for further research consist in the fact that Ukrainian audit firms can achieve further development and recovery in the post-war period with the help of smart management decisions, legislative support, and the introduction of online audits. The priority goal of the audit system should be to increase trust in the audit process and the auditor. This will increase the investment attractiveness of enterprises. Given the uncertainty and riskiness of financial statement users in the current economic environment, the introduction of online audits is a flexible mechanism that will allow receiving audit reports and will influence positive movements in the recovery of the Ukrainian economy, which is why further research is needed.

Six years of the Angels Initiative: Aims, achievements, and future directions to improve stroke care worldwide.

The rate of stroke-related death and disability is four times higher in low- and middle-income countries (LMICs) than in high-income countries (HICs), yet stroke units exist in only 18% of LMICs, compared with 91% of HICs. In order to ensure universal and equitable access to timely, guideline-recommended stroke care, multidisciplinary stroke-ready hospitals with coordinated teams of healthcare professionals and appropriate facilities are essential.Established in 2016, the Angels Initiative is an international, not-for-profit, public-private partnership. It is run in collaboration with the World Stroke Organization, European Stroke Organisation, and regional and national stroke societies in over 50 countries. The Angels Initiative aims to increase the global number of stroke-ready hospitals and to optimize the quality of existing stroke units. It does this through the work of dedicated consultants, who help to standardize care procedures and build coordinated, informed communities of stroke professionals. Angels consultants also establish quality monitoring frameworks using online audit platforms such as the Registry of Stroke Care Quality (RES-Q), which forms the basis of the Angels award system (gold/platinum/diamond) for all stroke-ready hospitals across the world.The Angels Initiative has supported over 1700 hospitals (>1000 in LMICs) that did not previously treat stroke patients to become "stroke ready." Since its inception in 2016, the Angels Initiative has impacted the health outcomes of an estimated 7.46 million stroke patients globally (including an estimated 4.68 million patients in LMICs). The Angels Initiative has increased the number of stroke-ready hospitals in many countries (e.g. in South Africa: 5 stroke-ready hospitals in 2015 vs 185 in 2021), reduced "door to treatment time" (e.g. in Egypt: 50% reduction vs baseline), and increased quality monitoring substantially.The focus of the work of the Angels Initiative has now expanded from the hyperacute phase of stroke treatment to the pre-hospital setting, as well as to the early post-acute setting. A continued and coordinated global effort is needed to achieve the target of the Angels Initiative of >10,000 stroke-ready hospitals by 2030, and >7500 of these in LMICs.

Plant-based food politics: veganism, quiet activism and small businesses in Sydney’s foodscapes

ABSTRACT Veganism is becoming more popular as the social, environmental, and ethical impacts of animal agriculture become better known. This is creating new opportunities and challenges as an array of economic actors seek to profit from and contribute to the movement. In this paper, we analyse how small plant-based food businesses are engaging with and influencing vegan politics through a case study of Sydney, Australia. Through interviews and an online audit, we analyse the motivations, goals and practices of small businesses; their geographies, inclusions and exclusions; and the benefits and tensions that arise from the merging of business with politics. We find evidence that small businesses are actively and creatively engaged in quiet, collaborative, affirmative and visceral forms of activism that prefigure the skills, ingredients, tastes and knowledge required to transition away from animal agriculture. However, we also find that plant-based businesses avoid the term vegan, are becoming whiter, and are producing more masculine and expensive foods, such as meat analogues, in response to market pressures. We conclude that small businesses are important but overlooked actors within vegan politics that are contributing to race, gender and class biases, and should be engaged with in the pursuit of less exploitative food systems.

Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): a protocol for a cluster randomised controlled trial

BackgroundFacilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals.MethodsA three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms—high- or low-intensity external remote facilitation or a no facilitation control group—in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation – Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes.DiscussionWe will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas.Trial registrationACTRN12622000028707. Registered 14 January, 2022.

Research on the Audit of Public Health Emergencies: A Case Study of The Online Audit of the COVID-19 Epidemic in Wuhan

Since COVID-19 outbreak, governments at all levels across the country have devoted huge amount of money to the epidemic prevention and control, in order to effectively cope with the emergency and to ensure that the effective use of funds, the public put forward higher request to the effective use of fiscal funds, to some extent also regulations to Social supervision department, in particular, the audit department has put forward higher requirements. Therefore, this paper investigated the online audit of COVID-19 outbreak in Wuhan to study its role in the process of epidemic prevention and control. This paper mainly analyzes the organizational structure of audit institutions and the status of online audit through sampling survey of audit staff in Wuhan and college students and other positions, and analyzes various problems in online audit work from multiple perspectives and puts forward solutions based on questionnaire survey and statistics. For some preventable emergencies, we can use data capture to analyze and predict the existing situation to strengthen the effect of prevention; We can also use the government's financial data on public expenditure to judge whether enterprises can independently face the public health crisis in the future. In addition, we also put forward some suggestions to deal with the problem of late information disclosure under the pandemic, and reduce the audit risk.

245 A PILOT STUDY EVALUATING USE AND ACCEPTABILITY OF A NATIONAL AUDIT TOOL AND MANUAL FOR PSYCHOTROPIC MEDICATIONS IN RESIDENTIAL CARE

Abstract Background Psychotropic medications are frequently prescribed for long-term care residents, even though the risks frequently outweigh the benefits. A draft tool was developed for self-audit of the appropriateness of psychotropic medications prescribed for non-cognitive symptoms for people with dementia in Residential-Care Facilities (RCF). Prior to national use, the audit tool, audit manual and training required piloting. Methods The case notes of ten residents with dementia were selected at random within a single RCF. A set of notes were audited by professional staff after online (pre-recorded) audit training, with subsequent feedback by the auditors on the process via focus groups/individual interviews. A second set of notes were then audited, with feedback via a brief survey. Results All auditors (7 nurses, 4 doctors, and 4 therapists) gave feedback via a focus group(n=4) or 1:1 interviews; 7 also completed the second-round survey. The pre-audit online training was welcomed but some auditors required additional support during the audit, especially if inexperienced or if there was a gap between training and audit performance. Improvement suggestions for the audit manual included shortening it; adding a glossary of terms, and additional information for decisions on the appropriateness of “as needed” (PRN) medications. Auditors reported difficulties with reading handwriting, locating information in the chart, and determining if a medication was newly or previously prescribed on occasion (due to inconsistencies with prescribing documentation). Conclusion Overall, the feedback was positive; all reported that the audit was relevant to their practice, and the manual and online training were useful. Future audits could be facilitated by electronic prescriptions, protected time to complete audits, and site audit leads (senior nursing or medical staff who are familiar with the residents, the audit topic, and with performing the audit). Inexperienced auditors should have, in addition to a training session, a supported auditing session.

Health-Oriented Marketing on Alcoholic Drinks: An Online Audit and Comparison of Nutrition Content of Australian Products.

Marketing, label design, and product innovation strategies are being used by the alcohol industry to position some products as "healthier choices." The aim of this study was to systematically document the content and prevalence of health-oriented marketing on alcohol products on the Australian market and to compare the online availability of nutrition information and the alcohol and nutrient content between products with and without such features. Health-oriented marketing features on all beer, cider, and ready-to-drink (RTD) premixed drinks, and selected wines on the website of the largest liquor retailer in Australia were audited using a systematic coding protocol. Nutrition information was sought from manufacturer/brand websites. A total of 54% of beers, ciders, and RTDs featured health-oriented marketing, the most common forms being natural imagery or descriptors, or references to fruit ingredients. Twenty-one percent of audited wines featured health-oriented marketing. The prevalence of specific features varied by product category. Online availability of nutrition information for alcohol products was poor (12% of beer, cider, and RTDs). Products with health-oriented marketing were lower in energy and alcohol content than those without but were still classed as full-strength alcohol on average. Health-oriented marketing is prevalent on alcohol products sold in Australia. In the absence of universal and standardized health warning and energy content information on labels, permitted health-oriented marketing has the potential to mislead consumers about product healthiness or to detract from the perceived harm associated with alcohol consumption. Research to test this proposition is now needed to guide labeling policy reform.

Enterprise Blockchain Network Audit Mode and Application

In recent years, the continuous development of blockchain has not only spawned many emerging industries, but also changed the development mode of many original industries, but also had a certain impact on the audit work. This paper attempts to collide the unique characteristics of blockchain with the traditional online audit work. Based on the existing online audit mode of Zhiyuan technology company, this paper puts forward the idea of building a new blockchain online audit platform, which is based on four modules: blockchain technical support module, auditee basic data module, blockchain audit application service module and audit access module, Complete the four steps of audit information operation process: data collection, data preprocessing, collection of audit data and formation of audit report. Finally, it puts forward optimization suggestions for the existing blockchain online audit mode, such as improving the audit early warning mechanism, establishing a comprehensive and high-quality blockchain online audit talent training system, and improving relevant systems and laws, in order to provide reference for subsequent development and application.

Vegetable content & variety of convenience cooking product recipes: an online audit of Australian supermarket products

ABSTARCT Meal/recipe bases are low-cost and popular convenience cooking products, requiring limited preparation time and cooking skills. Back-of-pack recipes provided on these products could help encourage vegetable consumption; however, the vegetable content of these recipes has not been examined. Therefore, an audit was conducted of recipes provided on recipe/meal bases (n = 91) sold online at two Australian supermarkets. Recipes included 1.58 standard serves of vegetables per suggested serving on average, with 75% of recipes providing <2 standard serves of vegetables, and recipes had low vegetable variety. Beef-based recipes had more standard serves of vegetables per standard serving than those based on chicken (p = 0.02). 45% of products had recipes taking <25 minutes. These results provide new insights into the vegetable content of recipes provided on meal and recipe bases and how these recipes could be adjusted to increase vegetable intakes. Results serve as a baseline to track future improvements in these recipes.

Laboratory professionals' attitudes towards ISO 15189:2012 accreditation: an anonymous survey of three Croatian accredited medical laboratories.

IntroductionEffective implementation and continual compliance with ISO 15189:2012 require ongoing commitment and active involvement of laboratory staff. Our aim was to assess attitudes regarding accreditation implementation by conducting a survey in three Croatian accredited medical laboratories.Materials and methodsAn anonymous survey consisting of 34 questions was distributed either electronically or in a paper form a week prior to scheduled annual audits. Distributions of answers regarding age, work experience, laboratory workplace, and education level and according to the respective laboratory were compared.ResultsThe overall response rate was 76% (225/297). Preference towards working in an accredited laboratory and a positive attitude were revealed by 70% and 56% participants, respectively, with better process documentation as the main advantage. Only 14% of responders considered themselves completely familiar with ISO 15189:2012. Total of 68% of responders felt that accreditation increases the usual workload, with excessive paperwork as the main contributor. Half of the responders declared partial agreement that accreditation requirements and expectations were clearly explained and claimed that their suggestions were taken into account only occasionally, which was especially emphasized by technical staff. The vast majority (89%) completely follow the prescribed protocols. Only 27% consider turnaround time monitoring useful. Competence assessment is considered efficient by 41% of responders. The majority (73%) prefer an online audit in times of COVID-19.ConclusionsDespite an overall positive attitude towards accreditation, further efforts are needed in providing better education about ISO 15189:2012 for technical staff and modifying formats of competence assessment, in order to achieve better adherence to ISO 15189:2012 requirements.

Compliance with Driver and Vehicle Licensing Agency guidance in a psychiatric inpatient setting

AimsDriving is complex, requiring adequate: attention and concentration, memory, insight and understanding, judgement, planning and the ability to self-monitor1. Psychiatric illness, and associated medications, may affect patients’ ability to drive safely. The DVLA is responsible for determining individuals’ safety to drive and produces guidance specific to psychiatric disorders. Patients must comply with relevant guidance and clinicians must determine patients’ driving status and offer appropriate advice about medications and any need to inform the DVLA. This audit aimed to determine the compliance with DVLA guidance on a single inpatient psychiatric ward within Merseycare NHS Foundation Trust, UK.MethodA retrospective review of electronic patient records was completed. Clerical staff identified all patients admitted to Windsor House from 1/8/20–30/11/20 (n = 42). Data relating to driving status and driving advice were collected onto individual patient audit proformas, and uploaded to the online Audit Management and Tracking (AMaT) system.Result100% of patients had diagnoses that would require the DVLA to be informed and 100% were prescribed medication with potential side effects that could impair ones’ ability to drive safely such as dizziness, drowsiness or impaired concentration2. Driving status was only documented for 12 patients (29%) and type of vehicle driven for only 6 patients (1 of whom had an HGV licence).Discussion of DVLA guidance within the last 3/12 by the mental health team was documented in 17% patients. Of these patients, appropriate driving advice was given to 86%. All patients advised to cease driving were willing to. No patients were advised about side effects of medications on driving. No notes evidenced if the DVLA had been informed of patients’ admission, diagnosis or medication regimes.ConclusionDiscussing diving status and DVLA advice with psychiatric patients is important but may not always happen in inpatient settings, despite most patients having a relevant diagnosis. Failure to determine driving status may mean some patients are not being given appropriate guidance as required. Counselling on medication side effects in relation to driving should be encouraged as the majority of patients are taking prescribed medication that can potentially impair driving. Recommendations to improve compliance include: adding “driving status” to admission clerking and ward review proformas, educating staff to actively discuss driving with inpatients and create discharge checklists which prompt discussing driving status, medications and driving advice, and to re-audit in 6 months time.

Evaluation of medical emergency team medication management practices in acute hospitals: A multicentre study

BackgroundMedical emergency teams use medications to rescue deteriorating patients. Medication management is the system of steps and processes, including prescribing, distribution, administration, and monitoring, to achieve the best outcomes from medication use. Systems or standards for medication management by medical emergency teams have not been defined. ObjectivesThe aim of the study was to propose potential solutions to improve medical emergency team medication management by evaluating medication supply and related medication management practices during medical emergency team activations and understanding clinicians' perceptions about medical emergency team medication management in acute hospitals. MethodsA prospective multicentre audit of intensive care unit–equipped hospitals in Victoria, Australia, was conducted. After advertisement and invitation via scheduled email newsletters to hospitals, a representative of the medical emergency team from each hospital self-administered an online audit tool during December 2019 and January 2020. Audit data were analysed descriptively, and perceptions were analysed using content analysis. ResultsResponses were received from 32 of the 44 (72.7%) eligible hospitals. At 17 of the 32 (53.1%) hospitals, arrest trolleys provided medications for medical emergency team activations, in addition to arrest calls. At 15 of the 32 (46.9%) hospitals, separate, dedicated medical emergency team medication supplies were used to care for deteriorating patients. Dedicated medical emergency team supplies contained a median of 20 (range = 8–37) medications, predominantly cardiovascular (median = 8, mode = 7, range = 4–16) and neurological medications (median and mode = 6, range = 0–11). Variation was observed in all storage and other supply-related medication management practices studied. The four most frequent categories of clinicians' perceptions described systematic challenges with availability of the right medication in the right place at the right time. ConclusionsCurrent supply and related medication management practices and clinicians' perceptions demonstrated further development is necessary for medication management to meet the needs of medical emergency team clinicians and their patients.

Auditing the scope of antithrombotic care in iPACT (International Pharmacists for Anticoagulation Care Taskforce) represented countries.

Countries strive to find suitable solutions to offer health services to their populations. Pharmacist-led services are a possible solution to supplement the care offer with a clear advantage of proximity, with demonstrated expertise in medication use. This paper aims to audit the scope of antithrombotic care services available; and to describe the arrangements adopted for meeting the needs of the population. A multi-stage project involved the development of the list of services, generated during a face-to-face expert meeting; the definition of each service by literature search; and their clustering into three main groups (general, specific and support); resulting in an online audit of each service's availability, the settings where the service was available and the possible providers. The audit was distributed to a taskforce devoted to antithrombotic care representing 22 countries, with response obtained for all. Most reported general services were Transfer of care and Comprehensive Medication Review. Among specific services, Point-of-care testing for INR and renal function and Patient Education on antithrombotic care (antiplatelets and anticoagulants) were the most frequent. Interprofessional Education as a support service was very common, but the use of the Choosing Wisely initiative to inform evidence-based decisions was still limited. There was wide diversity found in arrangements for the provision of services to support patients taking antithrombotic medication, albeit specific services were reported in over half the surveyed countries.

The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

BackgroundThe health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change.MethodsA mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis.ResultsBarriers and facilitators were analysed according the COM-B domains. “Capability” factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff “motivation” included skilled facilitation of training, trainees’ desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). “Opportunity” factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential.ConclusionsA wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing &gt;20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

ObjectiveTo conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK.MethodsBetween 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeon‐entered information was collected in 95 fields regarding the stricture aetiology, prior management, mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines.ResultsData on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow‐up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture was not always assessed anatomically before surgery. Urinary retention was a common symptom in men awaiting reconstruction. Short unifocal strictures of the anterior urethra were the commonest reason for referral, whilst lichen sclerosus and hypospadias generated a significant volume of revisional stricture surgery. Lower numbers of very complex interventions are required for the management of posterior urethral pathology. Although precise criteria for determining success are not clear, management of urethral reconstruction in the UK was found to have a low risk of Clavien–Dindo grade 3 or higher complications, and was associated with outcomes similar to those reported in contemporary series except in the management of posterior urethral fistulae.ConclusionsOnline databases can provide volume data on the management of reconstructive urethral surgery across a multiplicity of centres in one country. They can also indicate compliance with accepted standards of, and expected outcomes from, this tertiary practice.

Testing e-mail content to encourage physicians to access an audit and feedback tool: a factorial randomized experiment.

In Ontario, an online audit and feedback tool that provides primary care physicians with detailed information about patients who are overdue for cancer screening is underused. In the present study, we aimed to examine the effect of messages operationalizing 3 behaviour change techniques on access to the audit and feedback tool and on cancer screening rates. During May-September 2017, a pragmatic 2×2×2 factorial experiment tested 3 behaviour change techniques: anticipated regret, material incentive, and problem-solving. Outcomes were assessed using routinely collected administrative data. A qualitative process evaluation explored how and why the e-mail messages did or did not support Screening Activity Report access. Of 5449 primary care physicians randomly allocated to 1 of 8 e-mail messages, fewer than half opened the messages and fewer than 1 in 10 clicked through the messages. Messages with problem-solving content were associated with a 12.9% relative reduction in access to the tool (risk ratio: 0.871; 95% confidence interval: 0.791 to 0.958; p = 0.005), but a 0.3% increase in cervical cancer screening (rate ratio: 1.003; 95% confidence interval: 1.001 to 1.006; p = 0.003). If true, that association would represent 7568 more patients being screened. No other significant effects were observed. For audit and feedback to work, recipients must engage with the data; for e-mail messages to prompt activity, recipients must open and review the message content. This large factorial experiment demonstrated that small changes in the content of such e-mail messages might influence clinical behaviour. Future research should focus on strategies to make cancer screening more user-centred.