Audit Of Outcomes Research Articles

Riesgo de tromboembolismo venoso e implementación de medidas preventivas

ObjectiveTo identify the frequency of risk factors for venous thromboembolism in hospitalized medical patients and the use preventive measures by healthcare professionals. MethodA descriptive, cross-sectional, retrospective study including medical charts of 369 adult patients hospitalized in the Medical sector of a university hospital in São Paulo, Brazil, for at least 48h from 2015 to 2017. Sociodemographic data, clinical risk factors for venous thromboembolism, contraindication and implementation of chemical prophylaxis, and the occurrence of the disease were investigated. The use of preventive measures was calculated by following the guidelines of the Brazilian Society of Clinical Medicine and the risk of venous thromboembolism according to the Padua Prediction Score (high risk ≥ 4 and low risk < 4). ResultsThe prevalence of venous thromboembolism was 7.3% (n = 27). All patients had at least one risk factor for venous thromboembolism, the most prevalent being reduced mobility (74.2%), active cancer (70.7%), infection (27.1%), recent surgery (21.6%) and age ≥70 years (20.0%). Chemical prophylaxis was implemented in 70.3% of high-risk patients without contraindication and mechanical prophylaxis was applied in only one of the cases with an indication. ConclusionsAll patients had at least one risk factor for venous thromboembolism. However, there was a low rate of implementation of preventive measures by health care professionals. Therefore, there is a need for multiple interventions, including admission and permanent education of nurses regarding risk and prevention, warning systems and outcomes audit.

Treatment Outcomes for Locally Advanced Cervix Cancer: A Single Institution Experience

Regular audits are a key component to a quality radiation treatment program. In an effort to understand current practice and plan for future state we performed an outcomes audit of our locally advanced cervix cancer patients treated with concurrent chemotherapy, external beam radiation therapy and brachytherapy. Our objective was to determine treatment outcomes and late toxicity

Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital.

Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 ± 1.0 per patient), with a mean age of 57.0 ± 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 ± 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.

Correction: A 20-year audit of retinoblastoma treatment outcomes.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers.

PurposeTo evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers.MethodsCross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24–48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex.ResultsA total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50–59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092–1322).ConclusionsMass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.

Promoting Proactive Auditing Behaviors

We introduce the construct of auditor proactivity to the accounting literature. Since auditors work in complex, dynamic environments where complete directives are often unavailable, auditors need to be proactive to achieve quality audit outcomes. However, proactivity is often lacking in practice. Thus, we position auditor proactivity as a valuable but scarce determinant of audit quality. Drawing on theory from management, accounting, and psychology, we test hypotheses about how environmental and dispositional factors interact to encourage proactive auditing behaviors. Using an experiment, we find that auditors are more proactive when they have both higher autonomy and higher tacit knowledge compared to when either or both of these factors are absent. Our theory and findings inform academics, regulators, and practitioners about how work environments and policies could be modified to promote proactive auditing behaviors.

Air pollution, auditors' pessimistic bias and audit quality: evidence from China

Purpose This paper aims to investigate whether and how air pollution affects auditor behavior and audit quality. Specifically, the authors draw from studies of behavioral economics and psychology to develop a new prediction that air pollution-induced negative mood causes pessimistic bias in auditors’ risk assessments of client firms, which motivates them to put more effort into achieving higher audit quality. Design/methodology/approach This study uses a sample of Chinese public firms for the period 2013 to 2018 and an ordinary least squares model to examine the effects of air pollution on audit quality. Findings The results suggest that auditors exposed to higher levels of air pollution are more likely to put more effort into their audits, resulting in higher audit quality. Furthermore, the impacts of air pollution on audit quality are more pronounced when an auditor has a higher level of education, a major in accounting or a related subject and a position as a partner. A series of identification tests and sensitivity tests further support the main findings. Practical implications This study provides deeper insight into how air pollution affects auditors’ decision-making through its effect on mood. Social implications The findings have broad potential implications for auditing and other high-skill professions. Because air pollution-induced negative mood is a common occurrence and numerous psychological experiments have demonstrated the potentially adaptive and beneficial role of negative mood in decision-making for professions like auditing that need a more conservative, alert and detail-oriented cognitive style, negative mood may to some extent facilitate decision-making. Professionals may benefit from paying closer attention to the adaptive benefits of different moods. Originality/value Few studies empirically discuss the effects of auditors’ psychology on audit outcomes. This study responds to this research gap with analyzes of how air pollution-induced negative mood can affect auditors’ professional judgment and audit outcomes. Further, this study adds to the growing literature that examines how air pollution affects various aspects of the economy and enriches the literature on behavioral economics, providing empirical evidence from a large sample of the effects of an environmental stressor on individual auditors’ professional judgment.

An Investigation of U.S. Critical Audit Matter Disclosures

This study investigates the determinants, textual properties, and consequences of the newly disclosed U.S. critical audit matters (CAMs). We find that complexity, financial reporting issues, and the magnitude of accounts that require high degrees of judgment significantly determine the quantity and subject of CAM disclosures. Next, we use difference-in-difference designs to examine whether adopting the CAM disclosure requirement is associated with changes to management’s disclosures, market reaction, and audit outcomes. Using textual analysis, we document significant changes in financial statement footnotes referenced by CAMs, suggesting that management, alone or in conjunction with their auditor, change their disclosure in an apparent attempt to expand and clarify areas that may be scrutinized. Results reveal no overall market reaction or change in audit fees or quality. However, in cross-sectional analysis within CAM adopters, we find that variation in the number and textual properties of CAMs disclosed are significantly associated with abnormal returns and audit fees, suggesting they convey audit-specific risk information. In additional analysis, we utilize our well-specified determinants models to explore further outcomes of the unexpected non-disclosure of CAMs. Overall, our findings provide insights on the new CAM standard, and particularly demonstrate their relevance to management disclosure decisions and to the market.

An audit of emotional logic for mental health self-care improving social connection

IntroductionEmotional Logic is a practical contribution to self-care for mental health and adaptability, teaching how unpleasant loss emotions have useful purposes that enable healthy adjustments to changing circumstances. Measurable personal capacity outcomes result from SMART action plans that recover named personal values. New understanding about emotions cascades informally through families and communities at low cost. This proof of concept paper presents audits that define the theory of change for a prospective study of Emotional Logic for self-care in compassionate networked communities. MethodsComparative audits of mental health and resilience outcomes with two learning cohorts were conducted using GAD-7, PHQ-9, and ELDP questionnaires. Long-term outcome audits also asked if learners’ had shared their new understanding with others. Emotional Logic coaches categorised ELDP statements into those identifying change of individual or relational capacities. ResultsCohen’s d shows improved resilience on guided self-help learning with effect size 1.13 (p < 0.001) for anxiety and depression, and 0.91 for youth personality disorder. 31 % of improvement for mental illness measured by the ELDP is hypothesised to follow improved relational capacities measured by 13/34 (38 %) of its Likert scaled statements. ConclusionsTeaching people the useful purposes of their unpleasant loss emotions improves the quality of their social connections and their mental health. Developing this personal understanding empowers self-care in new challenging situations that might otherwise have led to professional or other dependencies. Outcomes measurement of truly values-based action plans enables a prospective study to be conducted in networked communities, achievable through social prescribing.

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

BackgroundAbdominoperineal excision (APE) for rectal cancer is associated with a relatively high risk of positive margins and postoperative morbidity, particularly related to perineal wound healing problems. It is unknown whether the use of a minimally invasive approach for the perineal part of these procedures can improve postoperative outcomes without oncological compromise. The aim of this study was to evaluate the feasibility of minimally invasive transperineal abdominoperineal excision (TpAPE)MethodsThis multicenter retrospective cohort study included all patients having TpAPE for primary low rectal cancer. The primary endpoint was the intraoperative complication rate. Secondary endpoints included major morbidity (Clavien–Dindo ≥ 3), histopathology results, and perineal wound healing.ResultsA total of 32 TpAPE procedures were performed in five centers. A bilateral extralevator APE (ELAPE) was performed in 17 patients (53%), a unilateral ELAPE in 7 (22%), and an APE in 8 (25%). Intraoperative complications occurred in five cases (16%) and severe postoperative morbidity in three cases (9%). There were no perioperative deaths. A positive margin (R1) was observed in four patients (13%) and specimen perforation occurred in two (6%). The unilateral extralevator TpAPE group had worse specimen quality and a higher proportion of R1 resections than the bilateral ELAPE or standard APE groups. The rate of uncomplicated perineal wound healing was 53% (n = 17) and three patients (9%) required surgical reintervention.ConclusionsTpAPE seems to be feasible with acceptable perioperative morbidity and a relatively low rate of perineal wound dehiscence, while histopathological outcomes remain suboptimal. Additional evaluation of the viability of this technique is needed in the form of a prospective trial with standardization of the procedure, indication, audit of outcomes and performed by surgeons with vast experience in transanal total mesorectal excision.

Shareholder Dissatisfaction and Subsequent Audit Outcomes

SYNOPSIS This study examines the association between shareholder dissatisfaction, as proxied using auditor ratification voting, and subsequent auditor effort and audit quality. We document that increases in shareholder dissatisfaction are associated with (1) higher audit fees and longer audit report lags, and (2) lower abnormal accruals and reduced likelihood of financial statement misstatements, in the subsequent period. These findings inform the debate about auditor ratification voting, as governance activists and some regulators argue to increase the role of shareholders in auditor selection despite opposition from some firms and the staff of the Securities and Exchange Commission. We provide empirical evidence that increases in shareholder dissatisfaction with the auditor are associated with increases in subsequent auditor effort and audit quality. This suggests that shareholder action (even nonbinding) may potentially influence subsequent audit outcomes.

Audit of the impact of the York faecal calprotectin care pathway on colonoscopy activity

BackgroundThe York faecal calprotectin care pathway (YFCCP) was developed to optimise effective primary care differentiation between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). We undertook an audit of...

Auditor Responses to Shareholder Activism

In this paper, we investigate how auditors respond to shareholder activism against their clients. Our study is important because activism may be viewed by auditors as a source of increased engagement risk, thereby impacting audit outcomes. The potential relationship between shareholder activism and audit outcomes leads us to predict that activism targets will pay higher audit fees and also will be more likely to receive adverse internal control opinions and first‐time going concern opinions. Our results, which support all three predictions, suggest that the public scrutiny associated with activism campaigns heightens auditors’ concerns about reputational damage and litigation risk. Consistent with this notion, we find that activism targets are more likely to experience accounting‐related lawsuits. We also find that the increased likelihood of adverse internal control opinions documented in our baseline tests reflects higher quality reporting rather than increased auditor conservatism. Overall, our findings suggest that activism campaigns spur auditor diligence while also increasing the possibility of negative outcomes that may not be fully anticipated by activist investors.

Diagnosis and management of acute cholecystitis: a single-centre audit of guideline adherence and patient outcomes.

The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed guideline adherence at our academic centre and its impact on patient outcomes. This is a retrospective chart review of patients with acute calculous cholecystitis who underwent cholecystectomy at our institution between November 2013 and March 2015. Severity of cholecystitis was graded retrospectively if it had not been documented preoperatively. Compliance with the Tokyo Guidelines' recommendations on antibiotic use and time to operation was recorded. Cholecystitis severity groups were compared statistically, and logistic regression was used to determine predictors of complications. One hundred and fifty patients were included in the study. Of these, 104 patients were graded as having mild cholecystitis, 45 as having moderate cholecystitis, and 1 as having severe cholecystitis. Severity was not documented preoperatively for any patient. Compliance with antibiotic recommendations was poor (18.0%) and did not differ by cholecystitis severity (p = 0.90). Compliance with the recommendation on time to operation was 86.0%, with no between-group differences (p = 0.63); it improved when an acute care surgery team was involved (91.0% v. 76.0%, p = 0.025). On multivariable analysis, comorbidities (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.19-1.85, p < 0.001) and conversion to laparotomy (OR 13.45, 95% CI 2.16-125.49, p = 0.01) predicted postoperative complications, while severity of cholecystitis, antibiotic compliance and time to operation had no effect. In this study, compliance with the Tokyo Guidelines was acceptable only for time to operation. Although the poor compliance with recommendations relating to documentation of severity grading and antibiotic use did not have a negative affect on patient outcomes, these recommendations are important because they facilitate appropriate antibiotic use and patient risk stratification.

P105: Subpectoral and prepectoral implant based breast reconstruction using acellular dermal matrix: An audit of surgical outcomes

Introduction: Post mastectomy implant based immediate breast reconstruction using subpectoral and prepectoral techniques have become standard practice in the United Kingdom (UK). Literature suggests that outcomes of both techniques are comparable. A comparative analysis was performed on the surgical outcomes of subpectoral versus prepectoral implant based surgery with acellular dermal matrix from a single institution in the UK.

P036: Local audit of clinical outcomes of new symptom referrals from primary care to park centre for breast care in June 2019

Introduction: Park Centre for Breast Care in Brighton provides triple assessment for East Sussex. The service is burdened but close to complying with 2WW performance standards. In Nottingham, a successful audit (Nottingham Breast Institute, 2019) and creation of a new GP referral proforma reduced the number of referrals by half over a sustained period.

Does the Presence of a General Counsel in Top Management Affect Audit Effort and Audit Outcomes?

SYNOPSISThis study examines whether the presence of a general counsel (GC) in top management affects audit effort and audit outcomes. Hopkins, Maydew, and Venkatachalam (2015) find that firms with GCs in top management have lower financial reporting quality and tolerate more aggressive financial reporting practices, which likely influences audit risk. Given the GCs' influence on the financial reporting process, we posit that auditors of firms with GCs in top management increase the amount of effort they expend to provide reasonable assurance that financial statements are stated fairly. We find that the presence of GCs in firms' top management is positively associated with audit effort but does not directly affect the likelihood that these firms will receive unqualified audit opinions that contain explanatory language. Our findings suggest that GCs influence the external audit market by participating in the financial reporting process.JEL Classifications: M42.Data Availability: Data are available from the public sources cited in the text.

Ushering in Antifungal Stewardship: Perspectives of the Hematology Multidisciplinary Team Navigating Competing Demands, Constraints, and Uncertainty.

BackgroundThe social, contextual, and behavioral determinants that influence care in patients at risk for invasive fungal diseases (IFD) are poorly understood. This knowledge gap is a barrier to the implementation of emerging antifungal stewardship (AFS) programs. We aimed to understand the barriers and enablers to AFS, opportunities for improvement, and perspectives of AFS for hematology patients at a major medical center in Australia.MethodsSemistructured, face-to-face interviews were conducted with 35 clinicians from 6 specialties (hematology, infectious diseases, pharmacy, nursing, radiology, respiratory), followed by thematic analysis mapped to a behavioral change framework.ResultsAccess to fungal diagnostics including bronchoscopy was identified as the key barrier to rational prescribing. Collective decision making was the norm, aided by an embedded stewardship model with on-demand access to infectious diseases expertise. Poor self-efficacy/knowledge among prescribers was actually an enabler of AFS, because clinicians willingly deferred to infectious diseases for advice. A growing outpatient population characterized by frequent care transitions was seen as an opportunity for AFS but neglected by an inpatient focused model, as was keeping pace with emerging fungal risks. Ad hoc surveillance, audit, and feedback practices frustrated population-level quality improvement for all actors. Antifungal stewardship was perceived as a specialized area that should be integrated within antimicrobial stewardship but aligned with the cultural expectations of hematologists.ConclusionsAntifungal stewardship is multifaceted, with fungal diagnostics a critical gap and outpatients a neglected area. Formal surveillance, audit, and feedback mechanisms are essential for population-level quality improvement. Resourcing is the next challenge because complex immunocompromised patients require personalized attention and audit of clinical outcomes including IFD is difficult.

Standards for the provision of antenatal care for patients with inflammatory bowel disease: guidance endorsed by the British Society of Gastroenterology and the British Maternal and Fetal Medicine Society

BackgroundPregnant women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes. Comprehensive guidelines on medical management have been published; yet, there is limited guidance on service...

A 20-year audit of retinoblastoma treatment outcomes.

ObjectivesTo evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB.MethodsRetrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey.ResultsOf 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5–9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001).ConclusionsIn our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.