Similar Audits Research Articles

A bibliometric analysis of geographic disparities in the authorship of leading medical journals

BackgroundIt has previously been reported that authors from developing countries are underrepresented in medical journals. Here, we aimed to build a comprehensive landscape of the geographical representation in medical research publications.MethodsWe collected bibliometric data of original research articles (n = 10,558) published between 2010 and 2019 in five leading medical journals and geolocated these by the institute of the corresponding authors. We introduced two simple metrics, the International Research Impact and the Domestic Self-Citation Index, to assess publishing and citing patterns by cities and countries.ResultsWe show that only 32 countries published more than 10 publications in 10 years equaling 98.9% of all publications. English-speaking countries USA (48.2%), UK (15.9%), Canada (5.3%), and Australia (3.2%) are most represented, but with a declining trend in recent years. When normalized to citation count, 9/32 countries published ≥ 10% more than expected. In total, 85.7% of the publication excess originate from the USA and UK. We demonstrate similar geographical bias at the municipal level. Finally, we discover that journals more commonly publish studies from the country in which the journal is based and authors are more likely to cite work from their own country.ConclusionsThe study reveals Anglocentric dominance, domestic preference, but increased geographical representation in recent years in medical publishing. Similar audits could mitigate possible national and regional disparities in any academic field.

An external stability audit framework to test the validity of personality prediction in AI hiring

Automated hiring systems are among the fastest-developing of all high-stakes AI systems. Among these are algorithmic personality tests that use insights from psychometric testing, and promise to surface personality traits indicative of future success based on job seekers’ resumes or social media profiles. We interrogate the validity of such systems using stability of the outputs they produce, noting that reliability is a necessary, but not a sufficient, condition for validity. Crucially, rather than challenging or affirming the assumptions made in psychometric testing — that personality is a meaningful and measurable construct, and that personality traits are indicative of future success on the job — we frame our audit methodology around testing the underlying assumptions made by the vendors of the algorithmic personality tests themselves. Our main contribution is the development of a socio-technical framework for auditing the stability of algorithmic systems. This contribution is supplemented with an open-source software library that implements the technical components of the audit, and can be used to conduct similar stability audits of algorithmic systems. We instantiate our framework with the audit of two real-world personality prediction systems, namely, Humantic AI and Crystal. The application of our audit framework demonstrates that both these systems show substantial instability with respect to key facets of measurement, and hence cannot be considered valid testing instruments.

221 Lynch Syndrome - Do We Really Screen for It?

Abstract Aim Firstly, assess the compliance of our Trust with the DG27 NICE Guidelines (2017) recommending universal screening of patients with Colorectal Cancer (CRC) for Lynch Syndrome (LS), using Immunohistochemistry or Microsatellite Instability testing. Secondly, provide a cost estimate for the Trust to implement universal screening for LS. Method Retrospective data collection for all CRC resection specimens reported by the Trust's Pathology Lab in 2019, and check of pathology reports, Clinic letters, and lab results through the Trust's electronic system for screening for LS. Cost estimates were calculated using information from the Histopathology Department and similar Audits by other NHS Trusts. Results From the 361 colorectal resection specimens examined at the Trust's Pathology lab, 340 were not screened for LS (NICE Guidelines compliance = 5.8%). Of the 21 screened, 12 patients did not have LS, and for 9 screening was not completed. By categorising the patients into groups by age, location of cancer, and presence of synchronous or metachronous cancers, we found that there was no consistent rationale behind screening (i.e., patients with phenotypical characteristics traditionally related to LS were not screened). We estimated that universal LS screening would cost the Trust approximately £25,000 annually. Conclusions There is extremely poor compliance with the NICE Guidelines in a Trust with one of the highest numbers of CRC resections annually. Even the Amsterdam Criteria are not used to screen patients for LS. Screening could change the surgical and oncological management of the patients and also suggest different surveillance and prophylaxis for the affected family members.

An audit of US FDA warning letters issued to sponsors, institutional review boards and investigators over a six-year period.

The present audit was carried out with the objective of evaluating warning letters (WLs) issued to trial sponsors, clinical investigators and institutional review boards (IRBs) by the United States Food and Drug Administration during a six-year period and compare it with two similar earlier audits. WLs were reviewed and classified as per stakeholders and further categorised as per predefined violation themes. The chi-square test was performed for trend analysis of WLs. A total of 62 WLs were issued to the three stakeholders. The maximum number of WLs were issued to the clinical investigators (36/62, 58.06%), followed by sponsors (19/62, 30.64%), and least to the IRBs (7/62, 11.29%). Among sponsors, lack of standard operating procedures for the monitoring, receipt, evaluation and reporting of post-marketing adverse drug events was the most common violation theme (8/19, 42.1%). Among clinical investigators, deviation from investigational plan was the most common violation theme (31/36, 86.11%.). For IRBs, inadequate documentation was the most common violation theme (6/7, 85.71%). We saw an overall reduction in the number of WLs issued to the stakeholders. Thus, we identified multiple areas on which each stakeholder should work for improvement.

An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals.

The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1-2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.

Measuring alcohol’s cost, the Russian-language AUDIT, home-drinking, guilt, shame and forgiveness, and alcohol use among sexual minority women

Measuring alcohol’s cost, the Russian-language AUDIT, home-drinking, guilt, shame and forgiveness, and alcohol use among sexual minority women

75 Treatment Escalation Plan (TEP) Completion Rates in General Surgery

Abstract Background TEPs ensure every patient has a ceiling of care formally documented, including a DNACPR decision. This pre-empts complications and provides guidance on how to appropriately manage acutely unwell patients. There is no national standard for TEPs. Our aim: to formally document the incidence of TEP completion in general surgery at a local District General Hospital. Method A multi-phase, cross-sectional study of 1. Inpatients on three general surgical wards, 2. TEP completion at post-take after a typical on-call cycle. Results 15.4% of TEPs were completed, of which 75% had a DNARCPR form. For the two post-take ward rounds, 5% and 7.7% of admitted patients had a TEP. Elective surgical/Enhanced recovery patients (ERP) did not have a TEP. Findings were presented locally, and posters placed in the surgical offices. Cycle 2: 19.6% and 10% completion rate for ward and post-take patients, respectively. Conclusions TEPs are rarely completed. Minimal improvement in completion rate was noted at cycle 2. TEPs are more commonly completed for patients not for resuscitation. Future aims include editing the surgical clerking proforma and the elective surgery/ERP paperwork to encourage completion, improving patient care. Currently we are arranging similar audits across other NHS trusts to determine if this is a national problem.

Impact of a smartphone app on prescriber adherence to antibiotic guidelines in adult patients with community acquired pneumonia or urinary tract infections.

BackgroundMobile phone apps have been shown to enhance guideline adherence by prescribers, but have not been widely evaluated for their impact on guideline adherence by prescribers caring for inpatients with infections.ObjectivesTo determine whether providing the Auckland City Hospital (ACH) antibiotic guidelines in a mobile phone app increased guideline adherence by prescribers caring for inpatients with community acquired pneumonia (CAP) or urinary tract infections (UTIs).MethodsWe audited antibiotic prescribing during the first 24 hours after hospital admission in adults admitted during a baseline and an intervention period to determine whether provision of the app increased the level of guideline adherence. To control for changes in prescriber adherence arising from other factors, we performed similar audits of adherence to antibiotic guidelines in two adjacent hospitals.ResultsThe app was downloaded by 145 healthcare workers and accessed a total of 3985 times during the three month intervention period. There was an increase in adherence to the ACH antibiotic guidelines by prescribers caring for patients with CAP from 19% (37/199) to 27% (64/237) in the intervention period (p = 0.04); but no change in guideline adherence at an adjacent hospital. There was no change in adherence to the antibiotic guidelines by prescribers caring for patients with UTI at ACH or at the two adjacent hospitals.ConclusionsProvision of antibiotic guidelines in a mobile phone app can significantly increase guideline adherence by prescribers. However, providing an app which allows easy access to antibiotic guidelines is not sufficient to achieve high levels of prescriber adherence.

Adult parenteral nutrition in the North of England: a region-wide audit

ObjectivesParenteral nutrition (PN) is widely used to provide nutritional support to patients with inaccessible or inadequate length of gut or non-functioning gut. The objective was to compare practice in PN...

Getting our house in order: an audit of the registration and publication of clinical trials supported by the National Institute for Health Research Oxford Biomedical Research Centre and the Musculoskeletal Biomedical Research Unit

ObjectivesTo audit the proportion of clinical trials that had been publically registered and, of the completed trials, the proportion published.Setting2 major research institutions supported by the National Institute of Health...

Audit of vancomycin and gentamicin dosing and monitoring in Connolly Hospital Blanchardstown (CHB) 2014

Background The dosing of vancomycin and gentamicin relies largely on the weight and renal function of a patient. Due to their narrow therapeutic index, these drugs also require therapeutic drug monitoring (TDM) during treatment to ensure efficacy, reduce potential for otoand nephrotoxicity, and reduce potential for resistance. Guidelines for the use of vancomycin and gentamicin, as well as a dosing calculator, is in place in CHB. This audit was performed around the appropriate prescribing and monitoring of these two antibiotics in CHB and findings were compared to similar audits carried out in 2010 and 2012.

The Royal College of Radiologists' Audit of Prostate Brachytherapy in the Year 2012

AimsThis audit provides a comprehensive overview of UK prostate brachytherapy practice in the year 2012, measured against existing standards, immediately before the introduction of new Royal College of Radiologists (RCR) guidelines. This audit allows comparison with European and North American brachytherapy practice and for the impact of the RCR 2012 guidelines to be assessed in the future. Materials and methodsA web-based data collection tool was developed by the RCR Clinical Audit Committee and sent to audit leads at all cancer centres in the UK. Standards were developed based on available guidelines in use at the start of 2012 covering case mix and dosimetry. Further questions were included to reflect areas of anticipated change with the implementation of the 2012 guidelines. Audit findings were compared with similar audits of practice in Europe, the USA and Latin America. ResultsForty-nine of 59 cancer centres submitted data. Twenty-nine centres reported carrying out prostate brachytherapy; of these, 25 (86%) provided data regarding the number of implants, staffing, dosimetry, medication and anaesthesia and follow-up. Audit standards achieved excellent compliance in most areas, although were low in post-implant dosimetry and in post-implant scanning at 30 days. ConclusionThis audit provides a comprehensive picture of prostate brachytherapy in the UK in 2012. Patterns of care of prostate brachytherapy are similar to practice in the USA and Europe. The number of prostate brachytherapy implants carried out in the UK has grown significantly since a previous RCR audit in 2005 and it is important that centres maintain minimum numbers of cases to ensure that experience can be maintained and compliance to guidelines achieved.

Long term retention of retigabine in a cohort of people with drug resistant epilepsy

PurposeTo assess the utility of retigabine (RTG) for epilepsy in clinical practice at a single UK tertiary centre. MethodsWe identified all individuals who were offered RTG from April 2011 to May 2013. We collected demographics, seizure types, previous and current antiepileptic drugs (AEDs), starting and maximum attained daily dose of RTG, clinical benefits, side effects, and reason to discontinue RTG from in- and outpatient encounters until February 28, 2014. Results145 people who had failed a median of 11 AEDs took at least one dose of RTG. One year retention was 32% and decreased following the safety alert by the US Federal Drug Administration (FDA) in April 2013. None became seizure free. 34 people (24%) reported a benefit that was ongoing at last assessment in five (3%). The most relevant benefit was the significant reduction or cessation of drop attacks or seizure-related falls in four women, this persisted at last assessment in two. The presence of simple partial seizures was associated with longer retention, as was a higher attained dose of RTG. Adverse effects were seen in 74% and largely CNS-related or nonspecific and affected the genitourinary system in 13%. ConclusionRetention of RTG was less favourable compared to data from open label extension studies of the regulatory trials. In comparison with historical data on similar retention audits retention of RTG at one year appears to be less than lamotrigine, topiramate, levetiracetam, pregabalin, zonisamide, and lacosamide, and slightly higher than gabapentin.

Auditing laboratory rodent biosecurity programs

A rodent biosecurity program that includes periodic evaluation of procedures used in an institution's vivarium can be used to ensure that best practices are in place to prevent a microbial pathogen outbreak. As a result of an ongoing comprehensive biosecurity review within their North American and European production facilities, the authors developed a novel biosecurity auditing process and worksheet that could be useful in other animal care and use operations. The authors encourage other institutions to consider initiating similar audits of their biosecurity programs to protect the health of their laboratory animals.

Postoperative Venous Thromboembolism Prophylaxis by General Surgeons in a Developing Country: A Survey

Venous thromboembolism (VTE) is the most common preventable cause of hospital death. Several audits in the west have demonstrated that appropriate thromboprophylaxis is not being offered to a large number of surgical patients. Similar audits are lacking in the Indian population, and a perception exists among Indian surgeons that Indian patients are not susceptible to VTE. Hence we undertook a survey to analyze the existing knowledge and practice of VTE prophylaxis amongst general surgeons in India. A questionnaire-based survey was conducted on 100 active general surgeons. We found that 97% of surgeons had encountered VTE in their practice, and 49% had encountered mortality from pulmonary embolism. 64% of surgeons do not routinely score patients preoperatively for their VTE risk, and only 33% reported the presence of an institute-based protocol for the same. There was a wide disparity in the prophylaxis methods used for each risk group, particularly in the moderate-risk group. These findings suggest the need for adoption of institute-based protocols for prophylaxis and the evolution of Indian guidelines for VTE prophylaxis.

PWE-283 Surveillance for hepatocellular carcinoma: a clinical audit

IntroductionIt is thought that mortality due to hepatocellular carcinoma (HCC) is rising in the Western world. This has been primarily attributed to the hepatitis C viral epidemic.1 HCC detected after...

Efforts to Change Transfusion Practice and Reduce Transfusion Rates Are Effective in Coronary Artery Bypass Surgery

Efforts to decrease allogeneic blood transfusion and avoid unnecessary transfusions in cardiac surgery are important because transfusions are associated with increased postoperative morbidity and mortality. The purpose of the present study was to evaluate the long-term effects of multidisciplinary efforts to reduce allogeneic blood transfusion rates and avoid unnecessary red blood cell (RBC) transfusions in primary elective coronary artery bypass graft (CABG) surgery. A retrospective observational study. A single center study in a university-affiliated hospital. A total of 450 patients undergoing primary elective CABG surgery during 2004, 2008, or 2010. The application of systematic multimodal perioperative blood-sparing techniques and interventions directed to change transfusion behaviors. The results from an audit on transfusion practices in 2004 were compared with similar audits performed in 2008 and 2010 using a before-and-after study design. The patient populations were comparable throughout the years. The median postoperative chest tube bleeding was decreased from 950 mL in 2004 to 750 mL in 2010. The proportion of patients transfused with allogeneic blood products was decreased from 64% to 47%. Overtransfusion with allogeneic RBCs defined as the proportion of patients transfused with RBCs discharged with hemoglobin >7 mmol/L (11.3 g/dL) was reduced from 36% to 16%. Multimodal efforts to change transfusion behaviors and decrease transfusion rates in CABG surgery have persistent effects for several years.

Mortality within 30 days of receiving systemic anti‐cancer therapy at a regional oncology unit: What have we learned?

Benefits to patients from systemic anti-cancer therapies (SACT) occur at a cost of significant toxicities that can be life threatening. Published data of SACT mortality outside clinical trials is limited with no published Australia data. We aim to establish local outcomes at a regional Victorian oncology center to allow comparison with limited international data. An audit was undertaken at Ballarat Health Services to analyze all deaths occurring within 30 and 60 days of receiving SACT (cytotoxic chemotherapy and targeted therapy) for epithelial malignancies and hematological malignancies (excluding acute leukemia), over a 12-month period. Hormonal therapy was excluded. Between 1 January and 31 December 2008, 378 patients received SACT. In total 13 deaths (3.4%) occurred within 30 days following SACT. Three deaths (23%) were definitely treatment-related - neutropenic sepsis, pneumocystis pneumonia and bowel perforation, respectively. Eight deaths (62%) were definitely unrelated to treatment. Most deaths were due to disease progression (six patients) For two patients (15%), the cause of death was unknown. Most patients were treated with palliative intent. Most patients were receiving first-line treatment (seven patients, 50%). A further five deaths (1.3%) occurred 31-60 days after SACT, four of which were due to disease progression. Our local outcome data are comparable to limited current international data. This type of audit reviews local outcomes and identifies factors contributing to mortality in order to improve standards of care. We encourage similar audits to establish national benchmarks of 30-day mortality rate.

Prophylaxis of venous thromboembolism in general surgery: guidelines differ and we still need local policies

Venous thromboembolism (VTE) prophylaxis has become a major issue for surgeons both in the UK and worldwide. Several different sources of guidance on VTE prophylaxis are available but these differ in design and detail. Two similar audits were performed, one year apart, on the VTE prophylaxis prescribed for all general surgical inpatients during a single week (90 patients and 101 patients). Classification of patients into different risk groups and compliance in prescribing prophylaxis were examined using different international, national and local guidelines. There were significant differences between the numbers of patients in high, moderate and low-risk groups according to the different guidelines. When groups were combined to indicate simply 'at risk' or 'not at risk' (in the manner of one of the guidelines), then differences were not significant. Our compliance improved from the first audit to the second. Patients at high risk received VTE prophylaxis according to guidance more consistently than those at low risk. Differences in guidance on VTE prophylaxis can affect compliance significantly when auditing practice, depending on the choice of 'gold standard'. National guidance does not remove the need for clear and detailed local policies. Making decisions about policies for lower-risk patients can be more difficult than for those at high risk.

The South African Human Language Technology Audit

Human language technology (HLT) has been identified as a priority area by the South African government. However, despite efforts by government and the research and development (R&D) community, South Africa has not yet been able to maximise the opportunities of HLT and create a thriving HLT industry. One of the key challenges is the fact that there is insufficient codified knowledge about the current South African HLT components, their attributes and existing relationships. Hence a technology audit was conducted for the South African HLT landscape, to create a systematic and detailed inventory of the status of the HLT components across the eleven official languages. Based on the Basic Language Resource Kit (BLaRK) framework Krauwer (ELRA Newslett 3(2), 1998), we used various data collection methods (such as focus groups, questionnaires and personal consultations with HLT experts) to gather detailed information. The South African HLT landscape is analysed using a number of complementary approaches and based on the interpretations of the results, recommendations are made on how to accelerate HLT development in South Africa, as well as on how to conduct similar audits in other countries and contexts.