Audit Of Outcomes Research Articles

Clinical Outcomes of Surgery for Age-related Cataract with Intraocular Lens Implantation in Two Hospitals in North-Central Nigeria

Aims: The study aimed to assess the post-operative presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) from six weeks and above post-surgery, of patients operated for age-related cataract with biometry-calculated IOL power and available IOL power implantation, in two hospitals in Jos, Nigeria.
 Study Design: Retrospective cross-sectional survey.
 Place and Duration of Study: Eye units of two mission Hospitals in Jos namely; Bingham University Teaching Hospital and the Faith Alive foundation Hospital, between June and August 2021.
 Methodology: Patients aged 40 years and above, who had undergone surgery for age-related cataract in the preceding 18 months in two hospitals in Jos and were six weeks or more post-surgery were consecutively enrolled into the study, after obtaining informed consent. Socio-demographic data and surgical history were obtained from patients and their surgical records. The PVA and BCVA were assessed and categorized based on World Health Organization guidelines. 
 Results: A total of 87 patients were examined within the study period. Post-operative PVA was good (≥6/18) in 32 (36.8%), borderline (<6/18-6/60) in 41 (47.1%) and poor (<6/60) in 14 (16.1%) participants. After refraction, the proportion of good outcomes increased to 78.2% with only 8.1% of outcomes remaining poor. Biometry-calculated IOL power and available IOL power use did not significantly influence visual outcome (P=.645 and P=.146 for PVA and BCVA respectively).
 Conclusion: Majority of participants had post-operative PVA in the borderline category with residual uncorrected refractive error as the principal cause. Regardless of the IOL power implanted, surgery for age-related cataract enhanced patients’ vision. This study has shown that the presence of biometry is a guarantee of refractive success. Hence, refractive outcome audits are essential.

Can EPIC Be a Low-Cost Alternative to HIPEC in Advanced Epithelial Ovarian Cancer in Resource-Constraint Settings? Experience from Tertiary Care Oncology Center.

Management of advanced ovarian cancer underwent a paradigm shift with advent of cytoreductive surgery and intraperitoneal chemotherapy. Hyperthermic intraperitoneal chemotherapy requires complex machinery and costly disposables, and increased operative time. Early postoperative intraperitoneal chemotherapy is a relatively less resource-intensive alternative way of intraperitoneal drug delivery. We started our HIPEC programme in 2013. In select cases, we offer EPIC. This study is an audit of outcomes to look into the feasibility of EPIC as alternative to HIPEC. We performed analysis of prospectively maintained database in the Department of Surgical oncology from January 2019 to June 2022. We had 15 patients who underwent CRS + EPIC and 84 CRS+ HIPEC. We did a propensity-matched analysis for demographics, baseline data and PCI and compared 15 CRS + EPIC with 15 CRS + HIPEC patients. We compared the perioperative outcomes-morbidity, mortality, length of ICU and hospital stay. Procedure time was significantly higher in the HIPEC compared to EPIC as HIPEC is an intraoperative procedure. Patients were admitted to intensive care unit (ICU) after surgery for a longer mean duration in HIPEC arm (1.4 + 0.7 days) compared to EPIC arm (1.2 + 0.41 days). Patients in HIPEC arm had a significantly shorter hospital stay (mean 7.93 vs. 9.93 days. Four patients in EPIC arm had Clavien-Dindo grade 3 and 4 morbidity compared to 1 patient in HIPEC arm. Hematological toxicity was more common in EPIC group. CRS with EPIC can be explored as an alternative to HIPEC in centres lacking facilities and expertise for HIPEC.

CLinician and patient characteristics effect on Antimicrobial Stewardship Interventions (CLASI) study.

To determine whether the gender of clinicians making antimicrobial stewardship recommendations has an impact on intervention acceptance rate. A retrospective, multivariable analysis of antimicrobial stewardship prospective audit and feedback outcomes. A multisite healthcare system including Mayo Clinic Rochester (MN), Mayo Clinic Arizona, Mayo Clinic Florida and 17 health-system hospital sites, where prospective audit and feedback is performed and documented within an electronic tool embedded in the medical record. The study included 143 Mayo Clinic clinicians (84 cisfemales and 59 cismales). Outcomes were analyzed from July 1, 2017, to June 30, 2022, for intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status of patient. Of 81,927 rules, 71,729 rules met study inclusion. There were 18,175 (25%) rules associated with an intervention. Most of the rules were reviewed by pharmacists (86.2%) and stewardship staff (85.5%). Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (P = .19). Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02-1.08; P = .001). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45-0.7; P < .001). Female and male clinicians were equally effective at prospective audit and feedback in a multisite antimicrobial stewardship program. Patients in the ICU were less likely to have stewardship interventions accepted.

P20 An audit of the effectiveness of a prehabilitation programme in patients having surgery for cancer

Abstract Introduction Three prehabilitation programmes for patients undergoing surgery for cancer, based around initial physical activity scores, commenced April 2022. An audit of key outcomes was undertaken on patients enrolled onto the main programmes. Methods Patients with cancer requiring surgery were initially assessed (April to Oct 2022) and offered 2-3 sessions per week at one of: a community-based gym with registered trainers, a hospital-based gym, or a programme to train at home. Here we report physical activity scores and incremental shuttle walk test at the beginning and end of the programme, in addition to the hospital length of stay (LoS). Results The mean (±sem) physical activity score for hospital gym patients (54.4±18.3, n=23) was significantly lower (p&amp;lt;0.001) than for those attending the community gym (180.5±26.5 n=47), but both groups showed a significant improvement (p&amp;lt;0.001) at the end of the programme (216.7±18.3 and 362.0±31.0, respectively). The initial mean (±sem) incremental shuttle walk test score for the hospital gym patients (126.5±19.8, n=17) was significantly lower than for those attending community gyms (415.6±30.1, n=34), but only those at the latter (487.1±29.1) managed a significant increase (p&amp;lt;0.001). Thirty-seven patients requiring colon surgery completed the prehabilitation programme. The median (IQR) LoS [5.2 (3.4-7.3) days] was significantly lower for these patients (p&amp;lt;0.05) compared with those at NUH who did not enter the programme [5.6 days (4.3-8.2) n=567]. Conclusion The prehabilitation programme increased physical activity for both normal and frail patients with cancer prior to surgery and this was associated with a reduction in LoS.

DOES INTERNATIONAL FINANCIAL REPORTING STANDARD NARROWS AUDIT EXPECTATION GAP?

The many arguments advanced by scholars as to International Financial Reporting Standard’s capacity to enhance audit procedures and outcomes underscores this research’s quest for determining whether International Financial Reporting Standard could help with the perceptional dilemma that triggered the long lingering Audit expectation gap crisis. To this end, this study assays stakeholders’ perception as to whether the adoption of International Financial Reporting Standard could have certain narrowing impact on Audit expectation gap. The study adopted a mixed research design (i.e. exploratory and survey designs) by which structured questionnaires were administered to a purposeful randomly selected sample of 400 respondents drawn from audit practitioners, academics, accounting standards issuers, and members of professional accounting bodies within the North Central States of Nigeria and the Federal Capital Territory to collect data which were analyzed using multiple regression with the help of STATA 13 software. Result of the analysis revealed that both International Financial Reporting Standard induced quality financial report and complexity of audit work could narrow audit performance expectation gap in a significant positive manner, while International Financial Reporting Standard’s induced audit quality was negative in narrowing the expectation gap. We recommend however, that even with the significant result leading to rejection of the null hypotheses, standard setters should look at ways to draw up standards that will harmonize accounting standards and auditing standards in a way that clearly spell out how every category of reportable transactions should be reviewed and reported so as to improve the quality of what auditors deliver to the public.

Temporal trends in cardiovascular risk factors, lifestyle and secondary preventive medication for patients with myocardial infarction attending cardiac rehabilitation in Sweden 2006–2019: a registry-based cohort study

ObjectivesRegistries have been highlighted as means to improve quality of care. Here, we describe temporal trends in risk factors, lifestyle and preventive medication for patients after myocardial infarction (MI) registered...

Snodgrass Hypospadias Repair At Ayub Teaching Hospital: An Audit Of Complications And Outcomes.

There are many reported techniques for the repair of hypospadias, and new ones are being reported, which suggests that none is perfect. This study reports the anatomical success rate when using Snodgrass Technique. In this descriptive case series, 296 patients who fulfilled the inclusion criteria, by being treated by Snodgrass urethroplasty, were enrolled. The study was conducted at the Department of Surgery, Unit-C, MTI, Ayub Teaching Hospital Abbottabad between May 2008 and June 2021. Mean age of the patients was 2.4±.8 years, 79.7% (n=236) had anterior (glanular, coronal, sub coronal) meatal location and 20.3 % (n=60) had middle urethral meatus (distal & mid-shaft). The mean operative time was 52 min. 5.1% of patients developed neo-meatal stenosis (n=15), 7.1% (n=21) patients develop a urethral cutaneous fistula (compared to 5% in larger centers, 16% from smaller centers), 11.8% (n=35) developed wound infection, 2% (n=6) had complete disruption. The cosmetic appearance of the penis was "excellent"/good (shape of meatus was slit-like and vertically oriented) in 60.1% (n=178) patients, "acceptable" in 30.1% (n=89), and "not acceptable" in 9.8% (n=29). Snodgrass technique has a low complication rate, offers an acceptable cosmetic outcome and can be successfully applied to a wide range of defects from distal to mid-shaft hypospadias. Common complications include urethral-cutaneous fistula and meatal stenosis; both occur in a low and acceptable number of patients.

The role of teacher educator virtual communities of practice (VCoPs) in mobilising policy engagement: A case study of the initial teacher training market review from England

ABSTRACT Attempts to solve perceived policy problems in Initial Teacher Education (ITE) have seen national and international jurisdictions increasingly centralising ITE curricula, coupled with monitoring and auditing of outcomes against defined sets of professional standards. This paper reports the findings of a documentary analysis of 75 items of publicly available literature generated by stakeholders between 2 July and 30 September 2021, in response to a Market Review of Initial Teacher Training in England. The paper outlines how online platforms and networks can serve as Virtual Communities of Practice (VCoP), which can mobilise teacher educators to engage with and critique policy making. Discourse emerging from the analysis of the 75 items focuses on key concerns associated with teacher supply, quality and questions the evidence for wholesale changes to ITE. This paper highlights that the voice of teacher educators in England is marginalised and offers a cautionary tale for colleagues currently immersed in international efforts to “reform” and “review” ITE. We argue that this case study illustrates the potential for the international sector to form a VCoP and through these, to challenge postulated “solutions” to espoused policy “problems” in ITE.

Single-centre experience with peptide receptor radionuclide therapy for neuroendocrine tumours (NETs): results using a theranostic molecular imaging-guided approach

AimTo summarise our centre’s experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy.MethodsWe describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks.ResultsIn the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28–87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence.ConclusionsLUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.

68 - Audit of real-life outcomes with PDL-inhibitors across the West of Scotland Cancer Network (WoSCAN) in non-small cell lung cancer (NSCLC)

68 - Audit of real-life outcomes with PDL-inhibitors across the West of Scotland Cancer Network (WoSCAN) in non-small cell lung cancer (NSCLC)

73 - A single centre retrospective audit of outcome of patients with EM4-ALK rearrangement positive metastatic non-small cell lung cancer (NSCLC)

73 - A single centre retrospective audit of outcome of patients with EM4-ALK rearrangement positive metastatic non-small cell lung cancer (NSCLC)

Do Shareholder Ratification Votes Impact Subsequent Audit Outcomes?

SUMMARY The Securities and Exchange Commission (SEC) and the Public Company Accounting Oversight Board (PCAOB) have justified audit-related disclosure rules by asserting that such information would be relevant for shareholders in auditor ratification voting decisions. The underlying assumption, stated more explicitly by activists and others, is that such voting can influence auditors’ subsequent actions. A recent study by Tanyi, Rama, Raghunandan, and Martin (2020) tests this assumption. Using data from 10,326 auditor ratification votes, Tanyi et al. (2020) find that higher than expected shareholder dissatisfaction of their external auditors is associated with higher audit quality and higher audit fees in the subsequent period. The results suggest that auditors should pro actively engage with audit committees if there is higher than expected shareholder dissatisfaction. Auditors can also expect regulators to use such evidence in future rule proposals by the SEC and PCAOB, given past actions by regulators.

Auditor health and audit outcomes before COVID-19

This study examines whether influenza-like illnesses (ILIs), a potential threat to the conduct of public company audits, are associated with audit outcomes. Because the peak months of flu season overlap with audit busy season, audit offices most at risk of ILIs may be adversely affected. The demanding nature of audit busy season and the culture of audit firms may compel employees to go to work sick, a phenomenon known as presenteeism. When auditors go to work with flu-like symptoms, cognitive functioning is impaired, resulting in brain fog. This impairment may influence auditors’ ability to exercise judgment and professional skepticism, leading to adverse outcomes. Using data collected from the Centers for Disease Control and Prevention (CDC) we find that the filing of audit reports is delayed and audit quality suffers in audit offices most at risk of influenza-like-illnesses. The observed effects of health impairments on company outputs have broad implications for both the audit profession and workplaces as a whole.

Knowledge Sharing in Auditor-Provided Tax Services: Experiences of Audit and Tax Personnel

ABSTRACT Research generally finds positive audit and tax outcomes associated with auditor-provided tax services (APTS), attributing knowledge sharing (KS) between tax and audit as the underlying cause but not observing it. This study contributes to the APTS literature by investigating experienced audit and tax professionals’ perspectives about when and how KS occurs. Results imply that KS occurs in two phases and is enhanced or inhibited by multiple factors related to knowledge relevance, motivation, opportunities, and culture. First, audit and tax personnel often share client information and their domain expertise while interacting during the audit, which enables identifying potentially valuable APTS. Second, further KS can occur during/following APTS performance, and APTS results may be shared back to benefit the audit. Our evidence shows that key factors may vary across phases, underscoring the importance of considering the full APTS process. Based on our findings, we suggest a number of future research opportunities. JEL Classifications: M41; M42.

Audit-Firm Profitability: Determinants and Implications for Audit Outcomes

We use a novel dataset that links audit-firm and client-firm financial statement information from the U.K.’s largest audit firms to examine drivers of audit-firm profitability and its implications for audit outcomes. We first explore the determinants of audit-firm profitability and conclude that Big-4 and non-Big-4 audit firms have fundamentally different profitability structures. Big-4 firms have higher profit margins than non-Big-4 firms. Furthermore, Big-4 profitability increases with client size and complexity, while non-Big-4 profitability is higher for smaller, private-firm clients. Next, we examine the relation between audit-firm profitability and audit outcomes. Using a battery of alternative outcome measures, we find that more profitable audit firms deliver higher audit quality. In supplemental analyses we show that the positive relation between audit-firm profitability and audit outcomes is generally stronger for more influential and illiquid clients (i.e. when auditors are exposed to more litigation risk). Our inferences are robust to several endogeneity controls, such as using an instrumental variables approach, controlling for client-firm and audit-firm fixed effects, employing lead-lag and changes specifications, and assessing bias from correlated omitted variables. Our study contributes to the literature by being the first to provide insights into audit-firm profitability and examine in detail its implications for audit quality.

Outcomes in Pregnant Women with Valvular Heart Disease from Portuguese-Speaking African Countries Treated in Portugal through an International Agreement of Health Cooperation.

We performed a clinical audit of maternal and fetal outcomes in pregnant women with valvular heart disease (VHD) from Portuguese-speaking African countries who were transferred for their care, during a twenty-year period, through a memorandum of agreement of international cooperation. A retrospective analysis of 81 pregnancies in 45 patients with VHD (median age 24, interquartile range 22-29 years) from 2000 to 2020 was performed. The main outcome measures were maternal cardiovascular and fetal outcomes. History of rheumatic heart disease was present in 60 (74.1%) pregnancies. Most were in New York Heart Association (NYHA) functional class I or II; at the first evaluation, 35 (43.2%) were on cardiac medication and 49 (60.5%) were anticoagulated. Forty-eight pregnancies had at least one valvular prosthesis, including 38 mechanical heart valves. During pregnancy, deterioration in NYHA functional class occurred in 35 (42.0%), and eight (9.9%) patients required initiation or intensified cardiac medication. Mechanical valve thrombosis complicated four (4.9%) pregnancies, all cases on heparin, and resulted in one maternal death. Haemorrhagic complications happened in 7 (8.6%) anticoagulated patients, in the immediate postpartum or puerperal period. The 81 pregnancies resulted in 56 (69.1%) live births, while miscarriage and fetal malformations occurred in 19 (23.5%) and 12 (14.8%) pregnancies, respectively. In multivariate analysis, vitamin K antagonist therapy was the only independent predictor of an unsuccessful pregnancy (p = 0.048). In a high-income country, successful pregnancy was possible with low rate of maternal events in women with VHD transferred from five low-middle income countries in Africa. The use of anticoagulation with a vitamin K antagonist was associated with an unsuccessful pregnancy.

Increased workload without clinical benefit: Results following implementation of the ACR-TIRADS system for thyroid nodules.

The ACR-TIRADS system for stratifying thyroid nodule malignancy risk has been widely promoted and implemented. We audited its introduction at a large public hospital in Auckland, New Zealand. Audit of outcomes following thyroid nodule fine needle aspiration (FNA) before/after ACR-TIRADS. Individuals undergoing thyroid FNA 2017-2019. From medical records, we obtained details from the pre-FNA ultrasound (nodule size, TIRADS points/levels, radiologist recommendation for FNA), Bethesda (B) cytology classification, histology and post-FNA follow-up. Four hundred and twenty-two individuals had 564 FNAs, 163 had surgery and 54 (13%) had cancer in the primary nodule. 37/54 (69%) cancers were papillary thyroid carcinoma (median size 25 mm, 87% ≥10 mm, 61% ≥20 mm). Following ACR-TIRADS introduction, FNA recommendations increased greater than twofold, FNAs performed by 71%-83%, and the monthly rate of FNAs and operations by 60% and 40%, respectively. However, the proportion of cancers/FNA remained similar (9.9% post-TIRADS vs. 8.7% pre-TIRADS). The proportions of FNA results remained stable for B2-B4 categories, but doubled (11% vs. 5%) for B5-B6: 15 FNAs were needed to identify an additional B5/B6 lesion. TIRADS-5 nodules had a higher proportion of B5/B6 (20%) and a lower proportion of B2 (30%) than TIRADS-3 (2%, 57%, respectively) and TIRADS-4 (9%, 56%) nodules. About 5 additional cancers/year were diagnosed, but they were more often small (49% vs. 8% <2 cm, 17% vs. 0% <1 cm). ACR-TIRADS introduction increased workload (FNAs and operations), without increasing the proportion of cancers/FNA. It led to a few more cancers being diagnosed, but many were small and of uncertain clinical significance.

Employing string similarity metrics of partners to estimate audit team continuity: determinant and its effects on audit outcomes and pricing

PurposePartners are responsible for allocating audit tasks and facilitating knowledge sharing among team members. This study considers changes in the composition of partners to proxy for the continuity of the audit team. This study examines the effect of audit team continuity on audit outcomes (audit quality and report lags), pricing and its determinant (lead partner experience), which have not been thoroughly examined in previous studies.Design/methodology/approachThis study employs string similarity metrics to measure audit team continuity. The study employs multivariate panel data regression empirical models to estimate a sample of 26,007 firm-years of listed Japanese companies from 2008 to 2019.FindingsThe study reveals that audit team continuity is negatively associated with audit fees, regardless of the auditor’s size. This finding contributes to the existing literature by showing that audit team continuity represents one of the determinant factors of audit fee. For clients of large audit firms, companies with higher (lower) audit team continuity issue audit reports in less (more) time. The experience of lead partners is a strong predictor of audit team continuity, irrespective of audit firm size. Audit quality is not associated with audit team continuity for either large or small audit firms.Originality/valueThis study proposes and examines audit team continuity measures that employ string similarity metrics to quantify changes in the composition of partners in consecutive audit engagements. Audit team continuity expands upon the tenure of individual audit partners, which is commonly used in prior literature as a measure of client–partner relationships.

A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.

The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa. A retrospective study was undertaken at a state-subsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant. Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23-33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001). Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension.

Quality improvement through audit: Zuclopenthixol acetate prescribing, monitoring and patient outcomes in a regional health service

Prescribers' expectations of Zuclopethixol Acetate's (ZA) efficacy and tolerability are shaped by clinical experience and organisational culture; however, these expectations may not be consistent with current evidence and best practice. Quality improvement project (QIP) through a process audit of ZA prescribing, monitoring and patient outcomes (adverse events) in order to identify issues requiring intervention to align with service standards and practices. QIP interventions resulted in a statistically significant shift in psychiatrist oversight, identifying high dose ZA with adverse outcomes and cessation of prescribing/administration within the Emergency Department. Clinically significant changes in patterns of prescribing were observed between pre-post intervention audits. Entrenching an evidence-based QIP approach to clinical practice can effect clinically significant patterns of practice change to improve safe prescribing and drug monitoring.