Report Of Compliance Research Articles

Accreditation of antimicrobial stewardship programmes: addressing a global need to tackle antimicrobial resistance.

Accreditation of healthcare services provides quality assurance of hospital practice to support safe and effective care for patients. Accreditation programmes focused on antimicrobial stewardship (AMS) have been developed in high-income countries (HIC) and recently the WHO has developed a toolkit to support AMS practice in low and middle-income (LMIC) countries. BSAC has developed their Global Antimicrobial Stewardship Accreditation Scheme(GAMSAS) for hospitals based on globally applicable standards. GAMSAS aims to support healthcare organizations to build measurable AMS programmes and to support spread of best practice. GAMSAS involves a desktop assessment by BSAC experts followed by a hospital visit to gather further insight into how a hospital's AMS programme operates. A final report of compliance with the GAMSAS standards and a recommendation about accreditation at one of three levels is formally approved at a GAMSAS panel meeting involving well-established global experts in AMS. The BSAC GAMSAS team reflect on progress during the first year and ambitions for future spread.

National Collegiate Athletic Association athletic trainers’ response to the Arrington settlement: management, compliance, and practice patterns

ABSTRACT The primary purpose of this study was to assess Athletic Trainers’ (ATs) report of NCAA member institution compliance with the Arrington settlement, the concussion lawsuit vs. the NCAA, and to elucidate compliance predictors. A secondary purpose was to provide a contemporary concussion management clinical practice pattern description among NCAA collegiate athletic trainers. Head Athletic Trainers from NCAA Division I, II, and III completed an electronic questionnaire in August 2020 regarding their institution’s response to the Arrington Settlement and their current concussion management clinical practice patterns. The 37-item questionnaire included AT and institution demographics, current concussion management policies, and response to the Arrington settlement with a specific focus on the five settlement requirements. An overall compliance score on the five requirements, compliance on the individual requirements, and concussion management practices are reported with descriptives. Regression was used to identify specific predictors of both overall and individual settlement requirements. An ANOVA compared compliance by NCAA division level. Being pressured to be non-compliant was assessed between sexes by a chi-square. There were 223 respondents (21.8%), and overall compliance was high (4.1 ± 0.7) with the five required Arrington Settlement components. Settlement requirement 1, pre-season baseline testing, and requirement 5, presence of trained personnel at all contact sport practices, had the lowest compliance rates at 44.8% and 73.3%, respectively. The number of sports the institution offered was the only significant predictor of each requirement. There was no difference in compliance between NCAA divisions. Although the overall rate of being non-compliant pressure was low (13.8%), females were 3.28x more likely report being pressured than males. NCAA institutions are generally compliant with the Arrington settlement; however, lack of clarity in the requirements, particularly requirement 1, raises potential concerns. Concussion management practices continue to incorporate multifaceted approaches and are largely consistent with current best practices.

Comparative report of compliance to precautionary measures against COVID-19 in Nigeria and Jordan

Purpose of the studyThe purpose of this study is to comparatively report the strategies for implementation of safety measures against the transmission of Covid-19 in Nigeria as the heart of Africa and Jordan as the nexus of Arab world. MethodologyThe methodology used in this study is systematic literature review (SLR) and content analysis of report of the secondary data on Covid-19 which was obtained from Nigerian Centre for Disease Control & Presidential Task Force in Nigeria and Jordanian National Committee for Epidemic. Main findingsThe report showed indicators of compliance to precautionary measures against the spread of Covid-19 in both Nigeria and Jordan. There was an imposition total lockdown in major citizens like Lagos & Abuja in Nigeria and Irbid in Jordan while partial lockdown in other parts of the countries. Also, both countries tried to comply with the safety measures provided by World Health Organization (WHO) against Covid-19 such as: the use of facemask, social distancing, hand sanitizers and school activities were suspended. However, there is no specific fine against the violators of precautionary measures in Nigeria as compared to what is obtainable in Jordan where fines of Jordanian Dinars of 20–50 was imposed. Applications of this studyThe report can be useful to Nigeria Centre for Disease Control & Presidential Task Force in Nigeria, Jordanian National Committee for Epidemic, health workers and policymakers towards strengthening compliance with safety measures that are put in place in curtailing further transmission of the virus. Novelty/originality of this studyMost studies on Covid-19 assessed the rate of the spread of the pandemic but this study attempts to comparatively examine the compliance of precautionary measures in combatting the spread of Covid-19 in both Nigeria and Jordan. The readers would benefit from the study by galvanizing efforts in ensuring the compliance to the safety measures against the transmission of Covid-19 in both Nigeria and Jordan.

Feasibility study of diet counseling (DC) with oral nutritional supplements (ONS) for advanced esophageal and gastric cancer during chemotherapy (CT) or chemoradiotherapy (CRT): First report of ONS compliance from a prospective randomized controlled clinical study (DiCON study).

17 Background: Most advanced esophageal and gastric cancer patients(pts) experience fatigue, anorexia, and may arise malnutrition and sarcopenia, for which effective treatment has not been established. Nutritional support especially protein supplementations may prevent loss of body mass related with malnutrition and sarcopenia. We therefore, conducted a prospective randomized study to explore compliance and the best available ONS intake for pts undergoing CT or CRT. Methods: Eligibility criteria included: chemo-naïve advanced gastric cancer or esophageal cancer; performance status (PS) of 0–1; pts who can eat more than as 50% as usual; age over 20 years. Pts were randomly allocated into four groups within each strata, i.e. esophageal or gastric cancer, Group A: Diet counseling (DC) only, Group B-1: DC and ONS 1 pack/day, Group B-2: DC and ONS 2 packs/day, and Group B-3: DC and ONS 3 packs/day. We use jelly type ONS which is easy to intake and include rich branched-chain amino acid. We assessed ONS compliance, the change of nutritional index (body weight, albumin, pre-albumin, and muscle mass), diet record (daily), and toxicity before CT or CRT and 14 days after administration of CT. Results: Among forty pts (11 in A, 11 in B-1,8 in B-2,10 in B-3) were enrolled from August 2017 to August 2018, median age was 64 years (range 46-81), median BMI was 20.6 (range 15-29), and 28 gastric cancer, 12 esophageal cancer. Median intake was 12 packs/2w (range 0-14), 15 packs/2w (3-28), 12 packs/2w (2-28), in B-1, B-2, and B-3 respectively. Mean compliance of ONS was 72.7%, 50.0% and 33.1%, in B-1, B-2, and B-3 respectively. There was a significant linear trend across the 3 groups (P = 0.0104). B-1 was significantly better than B-3 (P = 0.0270). There were no pts in group B-3 who could intake ONS for 14 consecutive days. Over 80% of pts in B-1 group were able to intake for 14 consecutive days. Conclusions: We found ONS 3 packs/day was clearly denied because of compliance. Choice of 1 or 2 packs/day should be determined by taking into account the total calories of foods. Clinical trial information: 000026705.

An Ongoing Peer Review Programme for Paediatric and Adult Haemoglobinopathy (HbO) Services in England Drives Improvements in Care

The National Health Service (NHS) in England and Wales provides care for approximately 15000 children and adults with HbO. A national peer review of paediatric and adult HbO services against a set of quality standards was commenced in 2010 aiming to obtain a clear picture of service provision. These initial visits confirmed a lack of investment and marked inequalities of care highlighting the need for improved facilities, staffing and the establishment of networks of care. The results of the second national peer review programme (2015/6) are reported here with comparative analysis of performance against quality standards allowing an opportunity to establish whether the programme has led to improvements in the quality of, and access to, care.MethodsServices were reviewed against a set of 51 quality standards established by a steering group of experienced UK clinicians from the UK Forum for Haemoglobin Disorders. They examined support for patients, staffing, training, facilities/equipment, service organisation, guidelines, governance/audit, clinical networks and commissioning. 32 centres were visited including all major city hospitals in England and smaller hospitals with significant HbO patient populations. Review visits were conducted by a team of doctors, nurses, patient representatives, psychologists and NHS managers and the process was overseen and supported by the West Midlands Quality Review Service. Following each review the centre received a standardised report of compliance highlighting areas of good practice and concerns.ResultsOverall the visits provide evidence of a progressive increase in compliance with the quality standard, more marked in paediatric services (fig 1 and 2). 14/16 (82%) of paediatric and 21/31 (68%) of adult centres showed an improvement in compliance. The percentage of change in compliance ranged from -12 to +39% in paediatric and -22 to +59% in adult centres.Other findings from the peer review visits showed:•Themes from patient feedback were difficulties accessing adequate emergency care and support for Day Care units providing open access pain control.•Out of hours transfusion was only available in 50% services, throughout the review process.•Inequity of access to automated apheresis with several large centres not being able to provide this service.•Inadequate dedicated medical and nursing time with a decrease in number of adult services with named lead nurse from 68% to 58% in successive reviews. A lack of specialist psychological support was almost universal and unchanged throughout the review period.•In the 2015/16 review only 25% of services had completed audits specified in the standards, but increased numbers of services were developing a rolling programme of audit and participating in research.•Assessment of pain control according to NICE Guidelines had been performed in most centres, however very few services were able to meet the 30 minute arrival to analgesia target.•Transcranial Doppler services were of an inconsistent standard and no national quality assurance tool existed for this investigation.•Increasing numbers of services (67% paediatrics, 75% adults) were participating in multidisciplinary meetings and this had improved from 47% in the previous review.ConclusionPeer review of NHS quality of care in England is mostly voluntary but generally valued. This is the first ever report of a nationwide iterative, quality standards-based HbO peer review programme. It was conducted with almost universal participation from individual services, highlighting the willingness of service providers to engage with this voluntary process. Thearguments to sustain such programmes include evidence of cost effectiveness but impact on outcomes is more difficult to demonstrate. This report demonstrates that higher rates of compliance with quality standards were observed following implementation of the peer review programme. In part this is likely to be driven by the peer review process and shows that this process can promote excellence in patient care. [Display omitted] [Display omitted] DisclosuresHoward:Bluebird Bio: Consultancy, Honoraria; Novartis: Honoraria, Speakers Bureau.

Phase II study of pre-operative panitumumab and external pelvic radiotherapy (RT) in locally advanced rectal cancer (LARC) patients (pts) (RaP/STAR-03 Study): Preliminary report of safety and treatment compliance.

e14502 Background: The treatment with fluoropyrimidines and concomitant RT is the standard care inLARC preoperative chemoradiation. The aim of RaP/STAR-03 study is to evaluate the activity and safe...

Definition of a model for hospital environmental safety through the Hospital Hygiene Unit activities: findings from a Budget Impact Analysis to estimate savings due to avoided infection in an Italian teaching hospital

Background Targeted environmental monitoring is needed to obtain hospital patients safety. For this reason, Hospital Hygiene Unit (HHU) of Gemelli Teaching Hospital (GTH) periodically analyzes and inspects 10 healthcare production processes (HPP) and then expresses, in accordance with scientific evidences and current legislation, a report of healthcare compliance or not, in order to protect both patient and healthcare personnel. Aim of this study is to carry out an economic assessment in …

Impact of push-through-packages with electronic devices for accurate drug taking

Improved compliance is an issue in medical care and a previous study showed noncompliance measured via a survey and by counting unused drug. However, it is difficult to assess the frequency and timing of noncompliance in real time. In order to address these issues, we developed paper-made electronic devices with press through packages (PTPs) which recorded the time and frequency when users opened the PTPs. Using these devices, we studied the actual practice of self-administration of a hypertension drug (once a day). The data of 37 subjects using PTPs with electronic devices showed a discrepancy between actual compliance and subject-reported compliance. Only one subject (2.8%) had 100% compliance. There were 11 (30%) subjects in the highest level compliance group and 8 (22%) in the lowest. In contrast, 35 subjects (95%) reported perfect compliance by their own evaluation. Using innovative devices, it is possible to observe time, frequency, missed doses, and misuse in self administration. From an analysis of the correlation between subject background and noncompliance, all subjects had an equal possibility of noncompliance. This is the first report of actual patient compliance with real evidence of timing and frequency. The innovative electronic devices are particularly necessary for accurate control of drug therapy and cost-effective therapy with expensive druguse.

Additional hemodynamic measurements with an esophageal Doppler monitor: a preliminary report of compliance, force, kinetic energy, and afterload in the clinical setting

The esophageal Doppler monitor (EDM) is a minimally-invasive hemodynamic device which evaluates both cardiac output (CO), and fluid status, by estimating stroke volume (SV) and calculating heart rate (HR). The measurement of these parameters is based upon a continuous and accurate approximation of distal thoracic aortic blood flow. Furthermore, the peak velocity (PV) and mean acceleration (MA), of aortic blood flow at this anatomic location, are also determined by the EDM. The purpose of this preliminary report is to examine additional clinical hemodynamic calculations of: compliance (C), kinetic energy (KE), force (F), and afterload (TSVR(i)). These data were derived using both velocity-based measurements, provided by the EDM, as well as other contemporaneous physiologic parameters. Data were obtained from anesthetized patients undergoing surgery or who were in a critical care unit. A graphical inspection of these measurements is presented and discussed with respect to each patient's clinical situation. When normalized to each of their initial values, F and KE both consistently demonstrated more discriminative power than either PV or MA. The EDM offers additional applications for hemodynamic monitoring. Further research regarding the accuracy, utility, and limitations of these parameters is therefore indicated.

Compliance with Baby-Friendly Policies and Practices in Hospitals and Community Health Centers in Quebec

Since 2001, Quebec's ministry of health and social services has prioritized implementation of the Baby-Friendly Initiative (BFI), which includes the original hospital initiative and its expansion to community services. The objective was to document across the province compliance with the BFI's Ten Steps to Successful Breastfeeding in hospitals, Seven Point Plan in community health centers (CHCs), and International Code of Marketing of Breast-Milk Substitutes (Code). Using managers/staff, mothers, and observers, the author measured the extent of implementation of indicators formulated for each step/point and the Code, based on the revised WHO/UNICEF recommendations. Mean compliance scores in Quebec were 3.13 for 140 CHCs (range, 0 to 7) and 4.54 for 60 hospitals/birthing centers (range, 0 to 10). The mean compliance score for the Code was 0.69 for both CHCs and hospitals/birthing centers. The evaluation documented marked variations in implementation level for each of the steps/points and the Code. Also, managers/staff, mothers, and observers differed in their report of BFI compliance for most steps/points and the Code. Facilities that had applied for or obtained BFI designation demonstrated higher compliance with the BFI than those that had not. Results disseminated to participating organizations allowed comparisons on a regional/provincial perspective and in relation to BFI-designated facilities. Furthermore, this first portrait of BFI compliance in Quebec provided provincial, regional, and local health authorities with valuable information that can be used to bring about policy and organizational changes to achieve the international standards required for Baby-Friendly certification.

A Winding Model for Thermal Stress Considering Viscoelastic Property of Plastic Film (1st Report, Stress and Temperature Dependence of Creep Compliance of Polypropylene Film)

Plastic film, formed as wound roll, is often stored and transported. Then the in-roll stress may vary over time due to viscoelastic property of the film. As a result, it could lead to wound roll defect such as slippage or blocking. One of the causes is that the film creeps in radial direction and circumferential direction depending on the stress and the temperature of the wound roll at a given time. It is important to consider the viscoelastic property on theoretical estimation of the in-roll stress in order to prevent the defect efficiently. In this study, a polypropylene film is applied as a plastic film and the creep compliances are measured by compression/tensile creep tests under various conditions. From the experimental results, it is shown that the film has anisotropic creep behavior, which depends on stress and temperature. Additionally, it is shown that stress and temperature significantly affect the radial creep compliance and the circumferential creep compliance, respectively. Furthermore, to estimate the creep compliance values on arbitrary stress/temperature condition, a prediction model expressed by the creep function is obtained based on the measurement values, which is able to apply on winding model.

Utility of the Emergency Department Observation Unit in Ensuring Stress Testing in Low-Risk Chest Pain Patients

Recent research has noted low rates of compliance among ED chest pain patients referred for outpatient stress testing. The practice at our institution, a 39,000 visits per year emergency department (ED), is to place chest pain patients considered low risk for acute coronary syndrome in an observation unit for serial biomarker testing and provocative cardiac testing. Our objective was to determine the rates of positive stress tests among this group and to extrapolate from this the potential missed positive stress tests if these patients were referred instead for outpatient stress testing. This was a retrospective chart review of all chest pain patients admitted to the ED observation unit between April 2006 and June 2007. Baseline information, including a history of coronary disease, was recorded. Patients underwent a treadmill stress test, nuclear stress test, or coronary CT scan at the discretion of the attending emergency physician and/or the consulting cardiologist. Rates of positive stress test or coronary CT and patient disposition (admission to an inpatient unit versus discharge for outpatient follow-up) were noted. A total of 353 patients underwent stress testing or coronary CT during the study period: 257 (72.8%) patients had an exercise treadmill echocardiogram, 61 (17.3%) patients underwent nuclear stress testing, and 35 (9.9%) patients had a coronary CT. Seventy patients (19.8%) had a history of coronary disease but had been considered appropriate for observation by the attending emergency physician. Thirty-nine stress tests were positive (11%) and 11 were indeterminate (3.1%). Among patients with no history of coronary disease, 20 stress tests were positive (7.1%), and 10 were indeterminate (3.5%). Of all patients with a positive stress test, 19 (48.7%) underwent cardiac catheterization and 1 (2.6%) had coronary artery bypass graft. Twenty-one of 39 patients with a positive stress test (54%) were ultimately admitted to an inpatient unit per the recommendation of the consulting cardiologist. Assuming a best-case scenario in which 70% of patients referred for outpatient stress testing actually have the testing done (based on a recent report of outpatient compliance), physicians would miss approximately 3.3% of patients with a positive stress test if these patients were discharged directly from the ED. Among chest pain patients admitted to an ED observation unit, the rate of positive stress tests was 11%. Approximately 3.3% of patients with positive stress tests may have been missed if these patients were instead referred for outpatient testing.

Financial Misreporting, Bribery and Penalty

The recent outburst of corporate failures has brought financial frauds and the liability of auditors to policy debates. According to GAAS, as the client firms need to pay the auditing fee, the better informed auditors could collude with the client firm and give a report of compliance for the clients. This paper first characterizes the current system in a principal-agent model considering the setting of penalties for frauds. We show that, the setting of penalties can indeed squeeze the size of feasible bribes. However, since the maximal penalty is fixed and given by law, there can be cases where there are still feasible bribes. No matter whether there are still feasible bribes or not, we conclude that the bad status will not be reported under the current auditing system. Then we propose a co-payment scheme, which requires the auditing fee be shared by a third party. We demonstrate that there exists an equilibrium in this scheme, where the social optimal contract is offered, the auditor puts in full effort and the client firm does not offer any bribe. The overall equilibrium rewards will be the same as the social optimal contract. We then single out the factors in the co-payment contract to compare the existing systems in the US and the UK.

A Phase III Trial to Compare Standard Versus Accelerated Fractionation in Combination With Concurrent Cisplatin for Head and Neck Carcinomas (RTOG 0129): Report of Compliance and Toxicity

Materials/Methods: Eligibility criteria included T3-4 primary squamous cell HNC with or without cervical lymphadenopathy. Patients with distant metastaseswere excluded.Patients randomized to HFRT received 75 Gy in 1.25 Gy/fraction twice daily while those randomized to HFRT+CT received 1.25 Gy/fraction twice daily to 70 Gy. Concurrent cisplatin 12 mg/m 2 /day and 5-FU 600 mg/m 2 /day were administered over five days during the first and sixth weeks of radiotherapy. Patients with $N2 presentations and a complete primary tumor response underwent neck dissection 6‐8 weeks after the completion of radiotherapy. Survival curves were estimated by the Kaplan-Meier method. The Cox-Mantel test was used to compare survival distributions between the HFRT and HFRT+CT groups. Results:Medianfollow-upis now113months forsurvivingpatients.Mostenrolledpatientshadprimary tumorsofthe oropharynx (45%), hypopharynx (20%) or larynx(16%) with either T3-4(88%) or N2-3 disease(53%). Patients receivingHFRT+CT achieved superior 10 year loco-regional control (LRC) and failure free survival (FFS) compared with HFRT alone (Figs. 1, 2 and Table 1). There was a trend towardsimproved cause specificsurvival(CSS). Freedomfrom distant failure(FFDF) didnot significantlydiffer with HFRT+CT versus HFRT alone. Conclusions: HFRT+CT improved 10 yr FFS and LRC compared with HFRT alone. There is a strong trend towards improved 10 yr CSS. The superiority of HFRT with concurrent CT over HFRT alone has since been confirmed in other phase 3 trials.

A Randomized Trial to Assess the Efficacy of Nighttime Bracing for Rotator Cuff Tendinopathy

Shoulder pain is a common presentation in the primary care setting. Standardized assessment and treatment protocols for the most part are not validated. PURPOSE: The purpose of this study was to assess the efficacy of a nighttime brace in the treatment of rotator cuff tendinopathy in a primary care setting. METHODS: Following IRB consent, 23 patients diagnosed with rotator cuff tendinopathy were randomized to nighttime treatment with a brace to limit active abduction to 5 degrees (n=11) or no brace (n=12). Inclusion criteria included shoulder pain of at least 1 month duration, 25–65 yrs of age, nighttime shoulder pain, no recent shoulder/neck trauma. All subjects were recruited from a primary care setting. Exclusion criteria included no history of upper extremity DVT, hypercoagulable state, or steroid injection of the shoulder during the one month study. Patients were instructed on a home PT program or formal PT and use of medication was monitored. The primary outcome variable was the Simple Shoulder Test (SST), a shoulder function scale consisting of 12 items that ask people about their ability to tolerate or perform 12 activities of daily living (ADL)1. Subjects were interviewed 7 and 28 days post initial evaluation to determine change in SST score. Data were analyzed with by an ANOVA with repeated measures. RESULTS: All 23 subjects completed the study. Self-reported medication use was similar between the two groups. Self report of compliance with PT was the same between the two groups. All subjects in the brace group showed an improvement in their SST score. Sixty-four percent reported at least a 25% improvement in their SST score. Six of the twelve patients in the no brace group reported no improvement in their symptoms or SST score. The improvement was greater for the brace group than the no brace group at 28 days (p<0.05). Conclusions: This study suggests that nighttime use of a brace to limit shoulder abduction is useful in patients with a clinical diagnosis of rotator cuff tendinopathy. Future studies should address longer term outcomes and if the current findings can be extended across various patient populations and clinical settings.

Emotional self-regulation in preschoolers: The interplay of child approach reactivity, parenting, and control capacities.

This study examined whether child temperamental approach reactivity moderated the association between 2 factors, parenting and child control capacities and child emotional self-regulation. Participants (N = 113) were 3- and 4-year-olds (M = 48 months, SD = 5.78) and their mothers. Emotional self-regulation was measured as observed persistence and frustration and as maternal report of compliance. Parental approach, avoidance, control, and warmth were observed during play and a frustrating wait. Child approach reactivity and control capacities (inhibitory control and soothability) were assessed via maternal report. Results suggested that maternal approach during the wait was associated with persistence and frustration, whereas maternal warmth during the play was associated with compliance. These effects, and those of child control capacities, depended on the level of child approach. The implications of reactivity-control interactions and parent-child goodness-of-fit for emotional self-regulation are discussed.

Noncustodial Parent's Report of Child Support Payments

The statistics concerning the extent of the problem of divorced fathers' nonpayment of child support have been primarily based on mothers' responses to survey questions. The present study provides fathers' reports, matched to mothers', as well as court record data. The court records are shown to be an underestimate. Not surprisingly, fathers' report of compliance (the percent of what they owed they actually paid) is much higher (27%) than mothers' report. The findings illustrate that both reports might be biased, in opposite directions. Data showed that ability to pay (as measured for example by continuous employment) is a key correlate of child support payment.

Can Ophthalmologists Correctly Identify Patients Defaulting from Pilocarpine Therapy?

We determined whether clinical measurements and assessments available to ophthalmologists could be used to identify patients who default from pilocarpine treatment. The measurements and assessments included intraocular pressure, pupillary diameter, pupillary reactivity to light, the patient's report of compliance, the physician's prediction of compliance, the patient's log of pilocarpine administration, and the weight of pilocarpine eyedrops utilized. Compliance with the pilocarpine regimen was measured with an unobtrusive eyedrop medication monitor. Intraocular pressure and pupillary diameter did not correlate with compliance to the regimen as measured by the eyedrop monitor. Pupillary reaction to light, the physician's prediction of compliance, a daily log of pilocarpine administration, the weight of pilocarpine utilized, and the patient's report of compliance correlated modestly with compliance as measured by the monitor (range of correlations, 0.19 to 0.24). However, none of these measures taken by itself or combined in any manner adequately distinguished patients with lower rates of compliance from those with higher rates of compliance. At present, the eyedrop monitor is the only reliable method for detecting patients who default from treatment.