Clinical Audit

A b s t r a c t Clinical guidelines are heralded as a positive contribution to improving quality of care and ensuring the effectiveness of care. From the perspective of the health services researcher, the authors propose a model of how informatics can support the implementation of clinical guidelines and their integration into systems for decision support and clinical audit. Each element of the model is discussed in turn.

Clinical guidelines are a positive contribution to improving the quality of care and assuring its effectiveness. However, clinical guidelines need to be integrated with other quality improvement initiatives to fulfil their potential. We propose a model of how informatics can support the implementation of clinical guidelines and their integration into systems for decision support and clinical audit. Each element of the model is discussed in turn and particular attention is paid to how informatics can also facilitate the involvement of patients in developing and using clinical guidelines. The word ‘patients’ is used to describe all users of health services.

Background: Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay. Methods: A cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV © (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit. Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels. Results: 47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = -0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness. Conclusions: This study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV © and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.

The Australian Clinical Dosimetry Service (ACDS) has demonstrated the capacity to perform a basic dosimetry audit on all radiotherapy clinics across Australia. During the ACDS's three and a half year trial the majority of the audits were performed using optically stimulated luminescence dosimeters (OSLD) mailed to facilities for exposure to a reference dose, and then returned to the ACDS for analysis. This technical note investigates the stability of the readout process under the large workload of the national dosimetry audit. The OSLD readout uncertainty contributes to the uncertainty of several terms of the dose calculation equation and is a major source of uncertainty in the audit. The standard deviation of four OSLD readouts was initially established at 0.6 %. Measurements over 13 audit batches-each batch containing 200-400 OSLDs-showed variability (0.5-0.9 %) in the readout standard deviation. These shifts have not yet necessitated a change to the audit scoring levels. However, a standard deviation in OSLD readouts greater than 0.9 % will change the audit scoring levels. We identified mechanical wear on the OSLD readout adapter as a cause of variability in readout uncertainty, however, we cannot rule out other causes. Additionally we observed large fluctuations in the distribution of element correction factors (ECF) for OSLD batches. We conclude that the variability in the width of the ECF distribution from one batch to another is not caused by variability in readout uncertainty, but rather by variations in the OSLD stock.

Objetivo: describir las características clínicas, epidemiológicas y sobre el diagnóstico en casos de sífilis gestacional (SG) y congénita altamente probable. Métodos: estudio observacional descriptivo que incluyó a todos los recién nacidos (RN) y sus madres con diagnóstico de sífilis congénita (SC) y SG atendidos en la Clínica Universitaria Bolivariana de Medellín, Colombia, del 1/01/2017 al 31/12/2021. Resultados: en 71 RN y sus madres con diagnóstico de sífilis, se identificaron 22 casos de SC altamente probable. En 22 gestantes, 58.1 % fueron menores de 26 años y 18.1 % ≤18 años. El 100 % contaba con afiliación al sistema de salud, pero 40.1 % no realizó controles prenatales. En el 59 % de la muestra, el diagnóstico se estableció en el tercer trimestre, siendo la sífilis latente indeterminada (45.4 %), latente temprana (27.2 %) y secundaria (13.6 %) las presentaciones clínicas más frecuentes. La ecografía obstétrica se realizó en 63.6 % (14/22) de las gestantes, reportando hallazgos sugestivos de sífilis fetal en 35.7 %. El 54.5 % de las pacientes que fueron tratadas para sífilis recibieron penicilina, 16.6 % <30 días antes del parto y 16.6 % presentó falla terapéutica. En 77.2 % de los casos la pareja no fue tratada o no se registró la información. En 22 RN 50 % fueron prematuros, 63.6 % tuvieron un peso <2500g, 72.7 % presentó manifestaciones clínicas y 7 (31.8 %) fueron hijos de madres adecuadamente tratadas. Conclusión: en el grupo de gestantes predominaron las mujeres jóvenes y adolescentes, alta inasistencia al control prenatal, diagnóstico tardío y subregistro del tratamiento recibido en sus parejas. En los RN predominó la prematuridad y el bajo peso y 7 neonatos fueron hijos de madres adecuadamente tratadas, lo que sugiere falla terapéutica que pudiera estar relacionada con un tratamiento tardío o estadios clínicos de la sífilis.

Background: Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Methods: Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. Results: There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p < 0.001 and 21.7 % vs. 50.5 %; P < 0.001 respectively after the second audit. There was no improvement in vital sign monitoring, delivery within two hours or blood grouping and cross matching. There was a decline in bladder catheterization (94 % vs. 68.9 %; p < 0.001. The overall mean care score in the first and second audits was 55.1 and 48.2 % respectively, p = 0.19. Healthcare factors (negative attitude, low numbers, poor team work, low motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Conclusion: Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

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In this paper, the traditional model of mentoring is briefly explained. A description of the current technique, which has developed from the traditional model, is then presented and a distinction made between mentoring and coaching, followed by a brief explanation of how mentoring, coaching and counselling make up a triad of helping activities. The authors then provide information on the use and impact of mentoring and coaching in some areas of human activity, other than dentistry, before outlining the application potential of these approaches in general dental practice. The paper concludes that the modern approach to mentoring and counselling offers a person-centred approach that is much more likely than traditional approaches to produce personal change, personal growth and personal development. Further aspects of this important and exciting subject will be explored in subsequent papers in this series.

In the initial TEOAE screening, 46 (30.7%) infants were found to have a hearing impairment. Out of which, 31 (20.7%) were confirmed to have hearing impairment after testing with AABR. 26 infants (50.9%) in the at-risk category (n=51) were found to have a hearing impairment. 86.7% of infants with exchange transfusion-requiring hyperbilirubinemia, and 70% of very low birth weight infants had a hearing impairment. Our study shows the high prevalence of hearing loss in at-risk infants. It highlights that universal two-stage hearing screening is feasible and necessary to implement in the resource-poor rural regions of India, especially in at-risk infants. Out of 46 detected with hearing impairment in our study, 26 were in the JCIH high-risk category, whereas 20 were not. This finding highlights that screening according to the JCIH high-risk registry (HRR), as is currently prevalent in numerous resource-limited Indian healthcare settings, could miss a significant number of cases. More research in this domain is warranted to elaborate on the additional risk factors apart from those included in the JCIH HRR. TEOAE Machines should be made available and accessible at all primary and rural health centres. Training of health care staff and professionals is essential for achieving an efficient screening programme. REFERENCE 1. Paul AK. Early identification of hearing loss and centralized newborn hearing screening facility-The Cochin experience.

Background: Deficiencies in investigation and audit of perinatal deaths result in loss of information thereby limiting strategies for future prevention. The Perinatal Society of Australia and New Zealand (PSANZ) developed a clinical practice guideline for perinatal mortality in 2004. Aims: To determine the current use and views of the PSANZ guideline, focussing on the investigation and audit aspects of the guideline. Methods: A telephone survey was conducted of lead midwives and doctors working in birth suites of maternity hospitals with over 1000 births per annum in Australia and New Zealand. Results: Sixty-nine of the 78 eligible hospitals agreed to participate. A total of 133 clinicians were surveyed. Only 42% of clinicians surveyed were aware of the guideline; more midwives than doctors were aware (53 vs 28%). Of those, only 19% had received training in their use and 33% reported never having referred to them in practice. Implementation of even the key guideline recommendations varied. Seventy per cent of respondents reported regularly attending perinatal mortality audit meetings; midwives were less likely than doctors to attend (59 vs 81%). Almost half (45%) of those surveyed reported never receiving feedback from these meetings. The majority of clinicians surveyed agreed that all parents should be approached for consent to an autopsy examination of the baby; however, most (86%) reported the need for clinician training in counselling parents about autopsy. Conclusions: Effective implementation programmes are urgently required to address suboptimal uptake of best practice guidelines on perinatal mortality audit in Australia and New Zealand.

The increasing mobility of patients and healthcare professionals across the countries of Europe has highlighted the wide variations in both medical training, and provision of medical competency and skills. The maintenance of the standards defining competency and skills have national and international implications and have proved challenging for national regulatory bodies. Thus each nation has introduced different types of Continuing Professional Development (CPD), recertification and relicensing systems. At the Symposium entitled: &quot; &#39;Certified … now what?&#39; On the Challenges of Lifelong Learning&quot; in August 2017 at the Association for Medical Education in Europe (AMEE) annual conference, we reviewed differing European national relicensing systems were reviewed. The review highlighted various lifelong learning and competence assessment approaches using examples from different medical specialties across several European countries.

Intraoperative monitoring of brain electrical activity is the standard of care for major surgical procedures. Although UK national suggested that the Bispectral Index (BIS) and Narcotrend (NCT) depth-of-anesthesia monitors are broadly equivalent, there is contradictory evidence in the literature comparing the two monitors. In this case series, we present a comparison between BIS and NCT indices recorded in 20 patients undergoing major hepatobiliary surgery. A total of 52,562 data pairs were obtained from 20 patients. Each index was then categorized according to whether the value was below, within, or above the target range (40-60 for BIS and 27-64 for NCT). Our results indicated discordance in the clinical guidance provided by these monitors in 29.3% of cases. Different timing of data collection between the two monitors and electrode position may have contributed to these findings. These observations mean that we cannot fully rely on electroencephalography monitoring to determine the depth of anesthesia. Therefore, it is important for the anesthetist continually to perform comprehensive assessment of the depth of anesthesia, including use of depth-of-anesthesia monitors, review of clinical signs, and use of monitored anesthesia carebased techniques where appropriate. In addition, monitoring of relative changes in the BIS: NCT index ratio over time would be more clinically useful than recording absolute values.

To evaluate waiting lists during the coronary artery bypass graft (CABG) diagnostictherapeutic pathway of patients, in order to detect the actual waiting time between diagnostic evaluation and surgery, and to explore if coronary angiography provides an option as a starting point of waiting lists for CABG patients. Methods: We analyzed 496 hospital discharge cards (year 2009) from main cardiac surgery units in Apulia, Italy. Exclusion criteria were emergency patients coming from regions other than Apulia, and CABG associated with cardiac valve surgery. Results: A total of 97.6% patients underwent CABG within 0-30 days of their reservation date, and 81.7% passed from the first diagnostic step to coronary angiography within 0-30 days. The mean time delay in the diagnostic (ie, the time elapsing from the date of first test performed to detect coronary heart disease and that of coronary angiography) and therapeutic (ie, the time elapsing from the date of waiting-list admission and that of cardiac surgery unit admission) phases was 17.3 ± 31.306 and 5.09 ± 9.375 days respectively; 27% and 19.8% underwent CABG within the same day or at least the day after reservation day, whilst 47.2% completed the diagnostic phase on the same day. The waiting lists for CABG surgery diagnostic-therapeutic phase in Apulia are short.

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

There are concerns regarding early years&#39; training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery. We recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on ...

Background: Assessing the quality assurance of providing work-ready anesthesia equipment in operating rooms is so vital. Most of the anesthesia-related adverse events are preventable by the identification and correction of anesthesia machine errors and equipment preparation in the pre-induction period. This paper aimed to keep a high-quality environment for workers and patients in the surgical operating theater. Materials and Methods: Data were collected after ethical clearance obtained from the institutional ethical review board, and daily observations of pre-induction anesthesia preparation were done in all surgical rooms at the start of each day and continuously before the next cases with a prepared anesthesia machine checklist. Descriptive statistical analysis and crosstabulation of each checklist with the type of anesthesia and urgency of surgery were done to determine the degree of staff compliance with daily preparations using SPSS version 22, and finally, results were presented by texts and graphs. Results: In this study, a total of 61 checking events with 19 items were involved during the study period. There were 893 (77.1%) fully met checking events, 205 (17.7%) not-met checking events(sodalime) 61 (5.3%) not available in anesthesia machine check and equipment preparation before use. Among 19 checklists, only three (power source plugged in, power source switched on, and functionality of monitoring) were perfectly completed; however, the rest sixteen checklists are in bad practice among them seven checklists (presence of functional self-inflating bag, automatic machine check, power source backup battery, anti-hypoxic device, ventilator, difficult airway equipment and scavenging systems) were checked below 90%. This study concludes there is poor compliance among anesthetists in pre-induction preparation and underperformed since all anesthesia machine checklists have zero tolerance for errors. . This paper recommends that every responsible anesthetist perform anesthesia machine check and equipment preparation regardless of the type of anesthesia and type of surgery and avoid professional negligence.

Background: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods: For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107, 087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86,. Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). Conclusions: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.

In our experience 5% of invasive malignant melanomas of the conjunctiva arising from areas ofprimary acquired melanosis with atypia spread to the ipsilateral nasal cavity and paranasal sinuses. Twenty one years after orbital exenteration for multicentric conjunctival melanoma an 82-year-old man was seen with an orbital recurrence, which had extended to the nasal cavity and paranasal sinuses through the nasolacrimal duct without invading the mucosa. This previously undescribed way of spread after the longest symptom-free interval following exenteration ever reported is illus- trated.

Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with 'acquired melanosis sine pigmento' are reported. The absence ofconjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. As a result orbital exenteration was required in three cases. This multicentric non-pigmented variety of conjunctival malig- nant melanoma tends to present later than pigmented forms and may require exenteration of the orbit as a primary procedure. ing in amelanotic acquired melanosis of the conjunctiva.' Griffith et all referred to the amelanotic precursor as 'acquired melanosis sine pigmento'. Jackobiec et all encountered a further four cases of multifocal conjunctival melanoma in association with amelanotic PAM, but did not mention the degree ofpigmentation of the malignant melanomas. We studied the clinical and histopathological features of four cases of multifocal amelanotic conjunctival melanoma arising in association with acquired melanosis sine pigmento.

There is great concern about the increasing rise in the rate of caesarean section in both developed and developing countries. This study was to ascertain the prevalence and compare outcomes of elective and emergency caesarean sections among women who deliver at the University of Cape Coast Hospital, Ghana. This retrospective study reviewed records of 645 women who delivered through caesarean sections during the period of January 2014 and December 2015. The prevalence of caesarean section was 26.9%. There was a significantly higher rate of adverse fetal outcomes (P=0.016) among babies born through emergency caesarean section. There were 12 (1.9%) women who had caesarean section done based on maternal request. The caesarean section rate found in this study was high. The lack of availability of technology for diagnosing fetal distress found in this study could possibly lead to over diagnosis of fetal distress. Thus availability of such diagnostic technology could reduce the high caesar...

The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20 years. In this study, we assessed associations between surgeons' experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates.

This case study explores the transformative impact of custom made prosthetic eye treatment on an individual who experienced a significant loss of vision. The focus is on the psychological, social, and functional benefits derived from the cosmetic restoration provided by a custom made prosthetic eye. The case highlights the intricate process of creating a personalized prosthetic that seamlessly blends with the patient's facial features, enhancing their self-esteem and overall quality of life. Additionally, the study delves into the challenges and considerations associated with custom made prosthetic eye care, including maintenance, potential complications, and the importance of ongoing support and followup. By presenting a detailed examination of this case, the study aims to shed light on the significant role custom made prosthetic eye treatment plays in improving the lives of individuals affected by vision loss.

This study aimed at looking into the demand and utilization of blood and blood components at a tertiary teaching hospital in Ethiopia. Methods: A cross-sectional study was conducted from June 1, 2018 to August 31, 2018 at St Paul's Hospital Millennium Medical College. Data on the types of blood products requested, indication for transfusion, availability of blood products and the utilization of different blood components, were collected by a structured questionnaire. Data were entered into SPSS version 20.1 and presented as frequency and percentage. Results: Blood and blood components were requested for 819 patients during the study period. Blood group O RhD positive was the commonest blood group (BG) accounting for 292 (35.7%) of the study participants followed by blood group A RhD positive 259 (31.7%). Physicians requested 3290 units of blood and blood components for transfusion; however, only 1840 (55.9%) were available and transfused. Of the 1840 transfused blood and blood components, 771 (42%) were packed RBC, 460 (25%) platelet, 352 (19%) fresh frozen plasma, and 257 (14%) whole blood. Postpartum hemorrhage was the commonest indication of blood transfusion in obstetrics, while severe anemia was the leading emergency situation in pediatrics and internal medicine departments. Abdominal trauma was the leading indication of blood transfusion in the department of surgery. This study finds a serious shortage of blood during emergency hours that may have a significant impact on patient survival. The hospital, in collaboration with the national blood bank, should devise a mechanism to alleviate the shortage.

Objectives To compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to identify predictors for somatic healthcare usage among older people with ID. Participants Equally sized cohorts, one with people with ID and one referent cohort, one-to-one-matched by sex and year of birth, were created. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Design Retrospective register-based study. Setting All specialist inpatient and outpatient healthcare clinics in Sweden. Outcome measures Data regarding planned/unplanned and inpatient/outpatient specialist healthcare were collected from the Swedish National Patient Register for 2002-2012. Diagnoses, previous healthcare usage, sex, age and cohort affiliation was used to investigate potential impact on healthcare usage. Results Compared with the referent cohort, the ID cohort were more likely to have unplanned inpatient and outpatient care but less likely to have planned outpatient care. Within the ID cohort, sex, age and previous use of healthcare predicted healthcare usage. Conclusions Older people with ID seem to have lower risks of planned outpatient care compared with the general population that could not be explained by diagnoses. Potential explanations are that people with ID suffer from communication difficulties and experience the healthcare environment as unfriendly. Moreover, healthcare staff lack knowledge about the particular needs of people with ID. Altogether, this may lead to people with ID being exposed to discrimination. Although these problems are known, few interventions have been evaluated, especially related to planned outpatient care.

Background: Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy). Methods: A multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records. Results: 614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11-20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed. Conclusions: The differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.

Gastrointestinal stromal tumors (GISTs), tumors characterized by c-KIT mutations, are the most frequent mesenchymal tumors of the digestive tract. The stomach is the most commonly involved site. Localization, size and mitotic rate are reliable predictors of survival and the two milestones of GISTs treatment are surgery and imatinib. This article is aimed to report the data of an audit, carried out on the morphological and clinical aspects of the disease and to review the present knowledge on GISTs. A total of 172 patients with GISTs (M : F = 1 : 1; mean age 65 years) were recruited. The stomach was the most frequently involved site. In 50% of the cases the tumor was smaller than 5 cm, whereas major symptoms were observed in 43% of the cases. Predictors of progressive disease were present only in a small percentage of cases but the disease was in the metastatic phase in over 25% of the cases at diagnosis. Familial aggregation was rare but a consistent share of the patients (21%) had other synchronous or metachronous cancers. The most frequent mutations were in-frame deletions and point mutations of c-KIT exon 11. This report confirms in part the available data on GIST in a consecutive series of patients recruited in Italy and shows that only large collaborative multicenter studies provide data sound enough to enable making reasonable clinical and therapeutic choices, and suggests that, as a measure of secondary prevention, a diagnostic definition should be obtained in all submucosal lesions of the GI tract and that GIST patients should be screened for second tumors.

This study aimed at looking into the demand and utilization of blood and blood components at a tertiary teaching hospital in Ethiopia. Methods: A cross-sectional study was conducted from June 1, 2018 to August 31, 2018 at St Paul's Hospital Millennium Medical College. Data on the types of blood products requested, indication for transfusion, availability of blood products and the utilization of different blood components, were collected by a structured questionnaire. Data were entered into SPSS version 20.1 and presented as frequency and percentage. Results: Blood and blood components were requested for 819 patients during the study period. Blood group O RhD positive was the commonest blood group (BG) accounting for 292 (35.7%) of the study participants followed by blood group A RhD positive 259 (31.7%). Physicians requested 3290 units of blood and blood components for transfusion; however, only 1840 (55.9%) were available and transfused. Of the 1840 transfused blood and blood components, 771 (42%) were packed RBC, 460 (25%) platelet, 352 (19%) fresh frozen plasma, and 257 (14%) whole blood. Postpartum hemorrhage was the commonest indication of blood transfusion in obstetrics, while severe anemia was the leading emergency situation in pediatrics and internal medicine departments. Abdominal trauma was the leading indication of blood transfusion in the department of surgery. This study finds a serious shortage of blood during emergency hours that may have a significant impact on patient survival. The hospital, in collaboration with the national blood bank, should devise a mechanism to alleviate the shortage.

Clinical registry data contains a wealth of information on patients, clinical practice, outcomes and interventions. Machine learning algorithms are able to learn complex patterns from data. We present methods for using machine learning with clinical registry data to carry out retrospective audit of clinical practice. Using a registry of stroke patients, we demonstrate how machine learning can be used to: investigate whether patients would have been treated differently had they attended a different hospital; group hospitals according to clinical decision making practice; identify where there is variation in decision making between hospitals; characterise patients that hospitals find it hard to agree on how to treat. Our methods should be applicable to any clinical registry and any machine learning algorithm to investigate the extent to which clinical practice is standardized and identify areas for improvement at a hospital level.

Backgrounds: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. Methodology/Principal Findings: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (,50%) addressed guidance on healthy life-styles. Conclusions/Significance: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

Objective: This study aims to compare the effectiveness of integrated schema therapy and mindfulness-based intervention with schema therapy and cognitive behavioral therapy (CBT) on the psychological flexibility of women exhibiting obsessive-compulsive symptoms.
Methods: The study used a quasi-experimental pre-test-post-test design with control and follow-up groups. The research was conducted on women with obsessive disorder who were referred to the Nedaye Agahi and Zehne Pouya Clinic in Tehran City, Iran, during the fall and winter of 2021. A total of 60 participants were selected using a convenience sampling method and were randomly assigned to three intervention groups: An integrated schema therapy and mindfulness-based intervention group, a schema therapy group, a CBT group and one control group. Data were collected using the psychological flexibility questionnaire and the Yale-Brown obsessive-compulsive scale. A repeated measures analysis of variance was conducted using SPSS software.
Results: The results revealed significant differences among all three treatment groups compared to the control. In particular, the integrated interventions of schema therapy and mindfulness, as well as schema therapy and cognitive behavioral therapy, demonstrated a significant effect on psychological flexibility scores (P<0.05) compared to the control group. However, the two-way comparisons for other differences were not significant (P>0.05).
Conclusion: Given the emotional and cognitive challenges faced by patients with obsessive disorders, it is essential to prioritize these aspects in the treatment process.

The gold standard in general radiography is to place a radiopaque anatomical side marker in the field of view for each radiographic image prior to exposure. The advent of digital radiography has allowed for anatomical side markers to be digitally added to films as part of post-processing. The aim of this audit was to identify whether general X-ray images performed in a tertiary Women&#39;s and Children&#39;s Hospital were being appropriately annotated with a definitive side marker, and to identify factors that may contribute to inappropriately labelled images. Four hundred images from 201 patients&#39; examinations occurring within a randomly selected time period were assessed to ascertain whether radiographic anatomical side markers were visible when images were viewed via the hospitals main viewing platform. The audit occurred in January 2014. The scope included both mobile and in-department general X-ray examinations, with the patient age range extending from 1 day to 18 years. O...

The last report of the National Audit Office (NAO) in 2023 released statistics about the dimension of what is still a big concern in the field of public health: one in six adults suffer from mental health disorders. While there is an extensive list of mental health disorders, this application of Cognitive-behavioural therapy has been mainly focused on the Common Mental Disorders (CMD). This concept includes two main categories (depression and anxiety) and six subcategories for anxiety disorders (Generalised anxiety disorder or GAD, Panic disorder, obsessive-compulsive disorder or OCD, Post-traumatic stress disorder or PTSD, Social anxiety disorder and Specific phobias). The percentage has increased following the Covid-19 pandemic from 11% to 27% (NAO, 2023). Furthermore, the percentage of people who could access psychological treatment before the pandemic hardly achieved 16% of the total affected population, according to Clark’s revision and summary of data (Clark et al., 2009, pp. 910-920). This problem is not new; therefore, discussing the improvement of mental health services at the NHS is still paramount.

The term "clinical inertia" is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood. OBJECTIVE: To describe one potential mechanism for clinical inertia, seen through the lens of clinician responses to a computerized hypertension reminder. DESIGN: Cohort study. PARTICIPANTS: A total of 509 hypertensive patients from 2 primary care clinics in urban Veterans Health Administration (VA) Medical Centers. All patients had elevated blood pressure (BP) values that triggered a computerized reminder. Given a set of possible responses to the reminder, clinicians asserted at least once for each patient that medication adjustments were unnecessary because the BP was "usually well controlled". Using recent BP values from the electronic medical record, we assessed the accuracy of this assertion. In most instances (57%), recent BP values were not well controlled, with the systolic BP (56%) much more likely to be elevated than the diastolic BP (13%). Eighteen percent of recent systolic BP values were 160 mmHg or greater. CONCLUSIONS: When clinicians asserted that the BP was "usually well controlled", objective evidence frequently suggested otherwise. This observation provides insight into one potential mechanism underlying clinical inertia.

Oral lesions of patients infected with human immunodeficiency virus (HIV) are a leading cause of morbidity among afflicted patients. In this study we summarized the most prevalent oral infections among HIV patients and the appropriate treatments. The most common infection is candidiasis followed by viral infection. The oral lesions have direct association with CD4 lymphocyte count. Also, these conditions are seen less in populations with ART medications. HIV infected patients with oral lesion should be diagnosed and receive appropriate treatment.

The results of this study increased insight into factors that explain differences in the judgments of IGZ inspectors. This study shows that IGZ inspectors systematically differ in the regulatory judgments they assign to similar health care institutions. This study also shows that IGZ inspectors systematically tend to assign judgments that are too positive compared with the IGZ corporate standards. In this study it was examined whether the reliability and validity of regulatory judgments varied between two types of instruments: a lightly structured instrument (LSI) used for the regulation of hospital care was compared with the highly structured instrument (HSI) used for the regulation of nursing home care. The results indicated problems with the reliability and validity of the judgments assigned with the HSI; however, reliability and validity could not be calculated with the LSI. The results showed that using an HSI is preferable to using an LSI. To analyze the interventions professi...

To examine the associations between the level of adherence to bronchiolitis clinical pathway recommendations, health care use, and costs. We conducted a retrospective cohort study of 267 patients ≤24 months old diagnosed with bronchiolitis from 12/2009 to 7/2012. Clinical pathway adherence was assessed by using a standardized scoring system (0-100) for 18 quality measures obtained by medical record review. Level of adherence was categorized into low, middle, and high tertiles. Generalized linear models were used to examine relationships between adherence tertile and (1) length of stay (LOS) and (2) costs. Logistic regression was used to examine the associations between adherence tertile and probability of inpatient admission and 7-day readmissions. Mean adherence scores were: ED, 78.8 (SD, 18.1; n = 264), inpatient, 95.0 (SD, 6.3; n = 216), and combined ED/inpatient, 89.1 (SD, 8.1; n = 213). LOS was significantly shorter for cases in the highest versus the lowest adherence tertile (...

IAEA AFRA TC in the last years is initiating in cooperation with its international partners and technical and expert’s staff from other IAEA departments the need of establishing the Master Program (MSc) and Postgraduate Diploma (PGD) in African Member States. This proposal aims to contribute to ongoing efforts by Member States in Africa to address the importance of Radiopharmacy in development of Good Radiopharmaceutical Practice in Nuclear Medicine and Departments and all institutions involved in the production, control, distribution and research of radiopharmaceuticals by promoting e-learning program in a combination of traditional teaching and practical work that provide effective, low cost educational opportunities to all professionals in a field of Radiopharmacy. The first component of the project will be to establish e-learning platform designed as an innovative learning apparatus that, working alongside conventional teaching methods, integrates education in all aspects of Rad...

Central line associated blood stream infection (CLABSI) has a tremendous effect on the outcome of patients, as well as a heavy financial burden on healthcare systems. CLABSI bundles were designed to decrease CLABSI, and were proven to improve CLABSI rates when compliance rates are high. Aims: To measure the percentage of compliance with individual CLABSI bundle components, as well as overall compliance, before and during an educational intervention. Methods: CLABSI bundle forms were retrospectively reviewed for compliance rates, during January, February, and March 2014. Then, an educational campaign, with different modalities was launched for three months (April, May, and June 2014), during which the same forms were being prospectively reviewed for compliance rates. Results: The overall compliance with CLABSI bundle during the pre-campaign period was 84%, while during the campaign the overall compliance rates increased to 96% (Z = ±3.762, p=0.0002). Conclusions: Compliance rates can...

IAEA AFRA TC in the last years is initiating in cooperation with its international partners and technical and expert’s staff from other IAEA departments the need of establishing the Master Program (MSc) and Postgraduate Diploma (PGD) in African Member States. This proposal aims to contribute to ongoing efforts by Member States in Africa to address the importance of Radiopharmacy in development of Good Radiopharmaceutical Practice in Nuclear Medicine and Departments and all institutions involved in the production, control, distribution and research of radiopharmaceuticals by promoting e-learning program in a combination of traditional teaching and practical work that provide effective, low cost educational opportunities to all professionals in a field of Radiopharmacy. The first component of the project will be to establish e-learning platform designed as an innovative learning apparatus that, working alongside conventional teaching methods, integrates education in all aspects of Rad...

Background: Survey research is common practice in podiatry literature and many other health-related fields. An important component of the reporting of survey results is the provision of sufficient information to permit readers to understand the validity and representativeness of the results presented. However, the quality of survey reporting measures in the body of podiatry literature has not been systematically reviewed. Objective: To examine the reporting of response rates and nonresponse bias within survey research articles published in the podiatric literature in order to provide a foundation with regard to the development of appropriate research reporting standards within the profession. Methods: This study reports on a secondary analysis of survey research published in the Journal of the American Podiatric Medical Association, the Foot, and the Journal of Foot and Ankle Research. 98 surveys published from 2000 to 2018 were reviewed and data abstracted regarding the report of response rates and non-response bias. Results: 67 surveys (68.4%) report a response rate while only 36 articles (36.7%) mention non-response bias in any capacity. Conclusions: The findings suggest that there is room for improvement in the quality of reporting response rates and nonresponse in the body of podiatric literature involving survey research. Both nonresponse and response rate should be reported to assess survey quality. This is particularly problematic for studies that contribute to best practices.

tilgangur: Kanna hvort sjúkrahúslega við valkeisaraskurði styttist án fjölgunar endurinnlagna með innleiðslu flýtibatameðferðar, og skoða hvaða þaettir hefðu áhrif á lengd legu. Efniviður: Flýtibatameðferð með útskriftarskilyrðum hófst í nóvember 2008 ásamt gaeðaeftirliti og ánaegjukönnun. Heimaþjónusta ljósmaeðra var í boði við útskrift innan 48 klst. Legutími allra kvenna sem faeddu einbura með valkeisaraskurði frá 1.11. 2008-31.10. 2009 (n=213; 182 í flýtibatameðferð) var borinn saman við legutíma árin 2003 (n=199) og 2007 (n=183) og tekið tillit til fyrri faeðinga. Endurinnlagnir og endurkomur 2007 og 2008-9 voru skoðaðar. Ástaeður lengri legu, líkamsþyngdarstuðull og fleira voru skráð í flýtibatameðferðinni. niðurstöður: Miðgildi legutíma styttist marktaekt úr 81 í 52 klst milli 2007 og 2008-9. Endurinnlagnir voru fjórar á báðum tímabilum og tíðni endurkoma sambaerileg. Árið 2008-9 gátu 66% heildarhóps útskrifast á innan við 48 klukkustundum. Konur í flýtibatameðferð voru ánaegðar með snemmútskrift. Sjúkrahúslega fjölbyrja var styttri 2007 en 2003, en óbreytt hjá frumbyrjum. Fyrri faeðingar höfðu hverfandi áhrif á legutíma 2008-9, þó frumbyrjur yngri en 25 ára í flýtibatameðferð vaeru líklegri til að liggja inni lengur en í 48 klukkustundir. Engin fylgni var milli líkamsþyngdarstuðuls og legutíma. Verkir hömluðu sjaldan útskrift við flýtibatameðferð og 90% töldu verkjameðhöndlun fullnaegjandi eftir heimkomu. Ályktun: Legutími eftir valkeisaraskurði hefur styst eftir tilkomu flýtibatameðferðar og heimaþjónustu. Flestar hraustar konur með eitt barn geta útskrifast snemma eftir valkeisaraskurð, án þess að endurinnlögnum fjölgi.

emerging paradigm within primary care to focus not only on disease (pathogenesis) but also on health (salutogenesis) might open new avenues for sexual health counselling. New technology also has potential: continuous education sessions have limited impact on prescribing habits for infrequent conditions with fast changing resistance patterns like gonoccocal infections; learning GP to use more and better their electronic prescription expert-system based on patient ICPC code (Prescriptor) is a better option and now available in most GP operating systems in the Netherlands.