Search results for: audit efforts

Authors: Sijuade A. A., Oguntoye J. P., Awodoye O. O., Adedapo O. A., Wahab W. B., Okediran O. O., Omidiora E. O., Olabiyisi S. O.

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Electronic voting systems have been introduced to improve the efficiency, accuracy, and transparency of the election process in many countries around the world, including Nigeria. However, concerns have been raised about the security and integrity of these systems. One way to address these concerns is through the implementation of electronic forensic election audit systems. This study aims to evaluate voters' intention to the adoption of electronic forensic election audit systems using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. In the study, the UTAUT model which is a widely used model in the field of information systems to explain the factors that influence individuals' intention to use a technology by integrating performance expectancy, effort expectancy, social influence, facilitating conditions, cost factor and privacy factor to voters’ behavioural intention was proposed. A total of 294 sample data were collected from a selected population of electorates who had at one time or the other participated in at least an electioneering process in Nigeria. The data was then analyzed statistically using Partial Least Square Structural Equation Modeling (PLS-SEM). The results obtained show that all variables have a significant effect on the electorates’ behavioral intention to adopt the development and implementation of an electronic forensic election audit system in Nigeria.

Keywords: election Audi, voters, UTAUT, performance expectancy, effort expectancy, social influence, facilitating condition social influence, facilitating conditions, cost factor, privacy factor, behavioural intention

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Authors: Iulian Clain

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In contemporary public administration, the demand for greater accountability, transparency, and efficient governance has intensified, particularly in the face of increasing public scrutiny and fiscal constraints. Internal auditing has emerged as a vital tool in strengthening governance structures, enhancing the effectiveness of public sector institutions, and ensuring compliance with regulatory frameworks. This paper examines the evolving role of internal auditing within public administration, with an emphasis on risk management, regulatory compliance, and fraud prevention. Building on institutional theory and risk management frameworks, this study explores how internal audits contribute to identifying operational inefficiencies, minimizing financial irregularities, and promoting ethical governance practices. Through case studies and comparative analysis of auditing practices across OECD nations, this research provides insights into how strategic internal audits can be harnessed to reinforce public sector governance, thereby improving the delivery of public services. The paper argues that the integration of internal audit findings into decision-making processes enhances not only financial accountability but also policy outcomes, fostering greater public trust in government institutions. Key recommendations are presented on how public institutions can further integrate internal auditing processes to enhance governance outcomes, focusing on best practices for institutionalizing audit functions within public sector governance frameworks. These findings are particularly relevant for policymakers, audit professionals, and public administration leaders striving to achieve better governance, operational efficiency, and integrity in the public sector.

Keywords: internal auditing role, public administration sciences, public administration audit, internal auditing in universities

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Authors: Georgia Mills, Rachel Parsonage

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Thrombocytosis is a platelet count above the upper limit of the normal range. An urgent referral is advised for counts over 1000 x109 and if the count is between 600-1000 x109 with certain conditions/age. A non-urgent referral is warranted when the level is above 450 × 109/L (for more than 3 months) or over 600 × 109/L on at least two occasions (4–6 weeks apart) or within the range 450–600 × 109/L with other haematological abnormalities. The aim of this audit is the assess how well Roseneath's general practice has adhered to the National Institute for Health and Care Excellence (NICE) guidelines for investigations and management of high platelet counts. Through the filtering tool on Vision, all blood results in the surgery were filtered to only show those with a platelet count above 450 x 109 /L. These patients were then analyzed individually to see where they fall on the current NICE guidance pathway for management. The investigations and management of thrombocytosis were generally poor. 60% of those who needed an urgent referral did not have it done. 30% of those who needed a follow-up blood test did not have it done. 60% of those needing a routine referral from complete investigations did not have it done. To improve the knowledge of NICE guidelines within the practice, a teaching session was delivered. Percentages then reached 100% in the 2nd audit. There is a lack of awareness of guidelines and education on thrombocytosis in primary care. Teaching sessions will benefit outcomes greatly

Keywords: platelets, thrombocytosis, management, referral

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Authors: Benjamin Bae

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This study investigates the relationship between the adoption of International Financial Reporting Standards (IFRS) and the performance of banks in a number of Middle East countries. We examine whether performance levels and audit qualities play any role in adopting the International Financial Reporting Standards (IFRS) in Middle East banks. This study hypothesizes that, in general, banks with high performance and audit quality measures tend to adopt the IFRS than low-performing banks, as the adoption of a new standard takes lots of time and expenses, which could be an additional burden to them. The results show that three hypotheses are strongly supported whereas the cultural factor hypothesis is not. Banks with high ROA and ROE tend to adopt IFRS than low-performing banks. Big banks are also more likely to adopt IFRS than small or medium-sized banks. Contrary to the hypothesis, the Islamic bank status as a cultural factor has some positive impact on the adoption of the banks in the region. Overall, this research adds to our understanding of the bank’s performance. First, evidence on the relationship between the adoption of IFRS and the bank’s performance should be useful to investors. Second, the findings of this study provide financial statement users with useful information about the bank’s performance measures.

Keywords: IFRS, financial performance, audit quality, culture, firm size

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Authors: Divya Pathak, James Sloane

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Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation make the repair more difficult for the operating surgeon. The oral and maxillofacial unit at the Royal Surrey Hospital is the tertiary referral center for maxillofacial trauma from five regional hospitals. This is a complete audit cycle of midface trauma referrals managed over a one year period. The standard set was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral. Retrospective data was collected over one year (01/11/2018 - 31/12/2019). Three key changes were implemented: an IT referral mailbox, standardization of an on-call trauma table, and creation of a trauma theatre list. Re-audit was carried out over six months completing the cycle. 283 midface fracture referrals were received, of which 22 patients needed surgical fixation. The average time from referral to outpatient follow-up improved from 14.5 days to 8.3 days, and time from referral to surgery improved from 21.5 days to 11.6 days. Changes implemented in this audit significantly improved patient prioritization to appropriate outpatient clinics and shortened time to surgical intervention.

Keywords: maxillofacial trauma, midface trauma, oral and maxillofacial surgery, surgery fixation

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Authors: Debarati Bhaumik, Diptish Dey

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Multilevel models, increasingly deployed in industries such as insurance, food production, and entertainment within functions such as marketing and supply chain management, need to be transparent and ethical. Applications usually result in binary classification within groups or hierarchies based on a set of input features. Using open-source datasets, we demonstrate that popular explainability methods, such as SHAP and LIME, consistently underperform inaccuracy when interpreting these models. They fail to predict the order of feature importance, the magnitudes, and occasionally even the nature of the feature contribution (negative versus positive contribution to the outcome). Besides accuracy, the computational intractability of SHAP for binomial classification is a cause of concern. For transparent and ethical applications of these hierarchical statistical models, sound audit frameworks need to be developed. In this paper, we propose an audit framework for technical assessment of multilevel regression models focusing on three aspects: (i) model assumptions & statistical properties, (ii) model transparency using different explainability methods, and (iii) discrimination assessment. To this end, we undertake a quantitative approach and compare intrinsic model methods with SHAP and LIME. The framework comprises a shortlist of KPIs, such as PoCE (Percentage of Correct Explanations) and MDG (Mean Discriminatory Gap) per feature, for each of these three aspects. A traffic light risk assessment method is furthermore coupled to these KPIs. The audit framework will assist regulatory bodies in performing conformity assessments of AI systems using multilevel binomial classification models at businesses. It will also benefit businesses deploying multilevel models to be future-proof and aligned with the European Commission’s proposed Regulation on Artificial Intelligence.

Keywords: audit, multilevel model, model transparency, model explainability, discrimination, ethics

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Authors: Tony Feng, Rea Thomson, Kathryn Greenslade, Ross Medine, Jennifer Easterbrook, Calum Arthur, Matilda Powell-bowns

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There are clear guidelines on taking group and screen samples (G&S) for elective arthroplasty and major trauma. However, there is limited guidance on blood grouping for other trauma patients. The purpose of this study was to review the level of blood grouping at a major trauma centre and validate a protocol that limits the expensive processing of G&S samples. After reviewing the national guidance on transfusion samples in orthopaedic patients, data was prospectively collected for all orthopaedic admissions in the Royal Infirmary of Edinburgh between January to February 2023. The cause of admission, number of G&S samples processed on arrival and need for red cells was collected using the hospital blood bank. A new protocol was devised based on a multidisciplinary meeting which limited the requirement for G&S samples only to presentations in “category X”, including neck-of-femur fractures (NOFs), pelvic fractures and major trauma. A re-audit was completed between April and May after departmental education and institution of this protocol. 759 patients were admitted under orthopaedics in the major trauma centre across two separate months. 47% of patients were admitted with presentations falling in category X (354/759) and patients in this category accounted for 88% (92/104) of those requiring post-operative red cell transfusions. Of these, 51% were attributed to NOFs (47/92). In the initial audit, 50% of trauma patients outwith category X had samples sent (116/230), estimated to cost £3800. Of these 230 patients, 3% required post-operative transfusions (7/230). In the re-audit, 23% of patients outwith category X had samples sent (40/173), estimated to cost £1400, of which 3% (5/173) required transfusions. None of the transfusions in these patients in either audit were related to their operation and the protocol achieved an estimated cost saving of £2400 over one month. This study highlights the importance of sending samples for patients with certain categories of orthopaedic trauma (category X) due to the high demand for post-operative transfusions. However, the absence of transfusion requirements in other presentations suggests over-testing. While implementation of the new protocol has markedly reduced over-testing, additional interventions are required to reduce this further.

Keywords: blood transfusion, quality improvement, orthopaedics, trauma

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Authors: T. Suleiman, C. Mchugh, H. Ranu

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Background; Asthma continues to be associated with poor patient outcomes, including mortality. An audit of the management of acute asthma admissions in our hospital in 2020 found poor compliance with National Asthma and COPD Audit Project (NACAP) standards which set out to improve inpatient asthma care. Clinical nurse specialists have been shown to improve patient care across a range of specialties. In September 2021, an asthma Nurse Specialist (ANS) was employed in our hospital. Aim; To re-audit management of acute asthma admissions using NACAP standards and assess for quality improvement post-employment of an ANS. Methodology; NACAP standards are wide-reaching; therefore, we focused on ‘specific elements of good practice’ in addition to the provision of inhaled corticosteroids (ICS) on discharge. Medical notes were retrospectively requested from the hospital coding department and selected as per NACAP inclusion criteria. Data collection and entry into the NACAP database were carried out. As this was a clinical audit, ethics approval was not required. Results; Cycle 1 (pre-ANS) and 2 (post-ANS) of the audit included 20 and 32 patients, respectively, with comparable baseline demographics. No patients had a discharge bundle completed on discharge in cycle 1 vs. 84% of cases in cycle 2. Regarding specific components of the bundle, 25% of patients in cycle 1 had their inhaler technique checked vs. 91% in cycle 2. Furthermore, 80% of patients had maintenance medications reviewed in cycle 1 vs. 97% in cycle 2. Medication adherence was addressed in 20% of cases in cycle 1 vs. 88% of cases in cycle 2. Personalized asthma action plans were not issued or reviewed in any cases in cycle 1 as compared with 84% of cases in cycle 2. Triggers were discussed in 30% of cases in cycle 1 vs. 88% of cases in cycle 2. Tobacco dependence was addressed in 44% of cases in cycle 1 vs. 100% of cases in cycle 2. No patients in cycle 1 had community follow-up requested within 2 days vs. 81% of the patients in cycle 2. Similarly, 20% of the patients in cycle 1 vs. 88% of the patients in cycle 2 had a 4-week asthma clinic follow-up requested. 75% of patients in cycle 1 were the recipient of ICS on discharge compared with 94% of patients in cycle 2. Conclusion; Our quality improvement project demonstrates the utility of an ANS in improving performance in the management of acute asthma admissions, evidenced here through concordance with NACAP standards. Asthma is a complex condition with biological, psychological, and sociological components; therefore, ANS is a suitable intervention to improve concordance with guidelines. ANS likely impacted performance directly, for example, by checking inhaler technique, and indirectly as a safety net ensuring doctors included ICS on discharge.

Keywords: asthma, nurse specialist, clinical audit, quality improvement

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Authors: Charlie Jeffkins

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Sickle cell disease is a serious life-limiting condition which can reduce the quality of life for many patients. Public Health England (PHE), in partnership with the Sickle Cell Society (SCS), has created guidelines to prevent severe complications from sickle cell disease. Data was collected from Children’s Hospital for Wales between 15/03/21-26/03/21. Methods: A manual search of patient records for children under the care of Rocket Ward and a key term search of online records was used. Results: Penicillin prophylaxis was given at 90 days for 89%, 77% of TCDs scans were done at 2-3 years, and 72% have had a scan in the last year. 53% of patients have had discussions about hydroxycarbamide, whilst 65% have started it. PPV vaccination was documented for 19%. Conclusion: Overall, none of the four standards were reached; however, TCD uptake has improved. There is a need for better documentation of treatment and annual re-audits.

Keywords: paediatric, haematology, sickle cell, audit

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Authors: Rozanne Janet Smith

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This article examined the corporate governance disclosures of the large and medium-sized auditing firms in South Africa. It is important that auditing firms disclose their practice of good corporate governance to the public, as they serve the public interest. The auditing profession has been criticized due to many corporate scandals in recent years. This has undermined the reputation of the profession, with experts and the public questioning whether auditing firms have corporate governance structures in place, and whether they are taking public interest into consideration. In South Africa there is no corporate governance code specifically for audit firms. Auditing firms are encouraged by IRBA to issue a transparency report in which they disclose corporate governance structures and application, but this is not compulsory in South Africa. Moreover, the information issued in these transparency reports is limited and often only focuses on audit quality, and not governance. Through a literature review it was found that the UK is one of only a few countries who has a corporate governance code for audit firms. As South Africa initially used the UK Cadbury report to develop the King IV Code, it was fitting to use the UK Audit Firm Governance Code as a benchmark to determine if audit firms in South Africa are disclosing relevant corporate governance information in their transparency reports and/or integrated reports. This study contributes to the existing body of knowledge by pursuing the following objective: To determine the improvement in the corporate governance disclosures of large and medium-sized auditing firms in South Africa through comparative research. Available data from 2019 will be used and compared to the disclosures in the 2023/2024 transparency and or integrated reports of the large and medium-sized auditing firms in South Africa. To achieve this objective a constructivist research paradigm was applied. Qualitative secondary information was gathered for the analysis. A content analysis was selected to collect the qualitative data by analyzing the integrated reports and/or transparency reports of large and medium-sized auditing firms with 20 or more partners and to determine what is disclosed on their corporate governance practices. These transparency reports and integrated reports were then read and analyzed in depth and compared to the principles stated in the UK Code. Since there are only nine medium-sized and large auditing firms in South Africa, the researcher was able to conduct the content analysis by reading each report in depth. The following six principles which are found in the UK Code were assessed for disclosure. (1) Leadership, (2) Values, (3) INED, (4) Operations, (5) Reporting, and (6) Dialogue. The results reveal that the auditing firms are not disclosing the corporate governance principles and practices to the necessary extent. Although there has been some improvement, the disclosure is not to the extent which it should be. There is still a need for a South African audit firm governance code.

Keywords: auditing firms, corporate governance, South Africa, disclosure

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Authors: A. Duncan, A. Blake, A. O'Gara, J. Fitzgerald

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Introduction: Acute traumatic rib fractures have significant morbidity and mortality and are a commonly seen injury in trauma patients. Rib fracture pain can often be acute and can prove challenging to manage. We performed an audit on patients with acute traumatic rib fractures with the aim of composing a referral and treatment pathway for such patients. Methods: From January 2021 to January 2022, the pain medicine service encouraged early referral of all traumatic rib fractures to the pain service for a multi-modal management approach. A retrospective audit of analgesic management was performed on a select cohort of 24 patients, with a mean age of 67, of which 19 had unilateral rib fractures. Results: 17 of 24 patients (71%) underwent local, regional block as part of a multi-modal analgesia regime. Only one regional complication was observed, seen with hypotension occurring in one patient with a thoracic epidural. The group who did not undergo regional block had a length of stay (LOS) 17 days longer than those who did (27 vs. 10) and higher rates of pneumonia (29% vs. 18%). Conclusion: Early referral to pain specialists is an important component of the effective management of acute traumatic rib fractures. From our audit, it is evident that regional blocks can be effectively used in these cases as part of a multi-modal analgesia regime and may confer benefits in terms of respiratory complications and length of stay.

Keywords: rib fractures, regional blocks, thoracic epidural, erector spina block

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Authors: S. M. Ahuja

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There are about 12000 stone crusher units in India and are located in clusters around urban areas to the stone quarries. These crushers create lot of fugitive dust emissions and noise pollution which is a major health hazard for the people working in the crushers and also living in its vicinity. Ambient air monitoring was carried out near various stone crushers and it has been observed that fugitive emission varied from 300 to 8000 mg/Nm3. A number of stone crushers were thoroughly studied and their existing pollution control devices were examined. Limitations in the existing technology were also studied. A technology consisting of minimal effective spray nozzles to reduce the emissions at source followed by a containment cum control system having modular cyclones as air pollution control device has been conceived. Besides preliminary energy audit has also been carried out in some of the stone crushers which indicates substantial potential for energy saving.

Keywords: stone crushers, spray nozzles, energy audit

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Authors: Yasmin Umar Assegaf, Falikhatun, Salamah Wahyuni

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This study aims to provide empirical evidence about the influence of Islamic Corporate Social Responsibility Disclosures of the financial performance of Islamic banking with the characteristics of the company, as a control variable in Islamic banking in Indonesia. ICSR disclosures are an independent variable, while the Financial Performance is the dependent variable (proxied by Return on Assets (ROA), Return on Equity (ROE), Income Expense Ratio (IER), and Non-net Interest Margin (NIM). The control variables used are firm size, firm age and the type of audit. The population of the study was all Islamic Banks (BUS) operate in Indonesia. The research sample is Islamic Commercial Bank which has existed in Indonesia since 2002 and publishes financial statements between the years of 2007-2011. The sample of the study were include 31 Annual Report published. The results of this study concluded that there are significant influences between the ICSR Disclosures and financial performance. The disclosure is partially effect on ROA, IER and NIM, whereas there is no influence on ROE. Further result shows that all control variables (Firm Size, Age, and Type of Audit Companies) does not have any influence on ICSR Disclosures in Indonesia. This research gives a suggestion for further research to compare these ICSR disclosures in Indonesia with ICSR disclosures in other countries that have Islamic banking, by using other measure variables of financial performance, to get more comprehensive model and real picture.

Keywords: ROA, ROE, IER, NIM, company size, age of the company, audit type, Islamic banking

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Authors: Aamna Tufail, Catherine Anyanwu

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Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

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Authors: Bela Sulistyaguna, Yuli Chomsatu Samrotun, Endang Masitoh Wahyuningsih

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The purpose of this research was to analyze the influence of company size, liquidity, profitability, leverage, company age, industry type, board of director, board of commissioner, audit committee and public ownership on the corporate social responsibility disclosure. The grand theories of this research are agency theory, stakeholders theory, and legitimacy theory. Analysis of data using multiple linear regression method with SPSS 22.0 for mac. The sample consists of companies listed on the Indonesia Stock Exchange (IDX) and disclosed the Global Reporting Initiative (GRI) sustainability reports from 2013 to 2018. The final sample of this research was 19 companies that obtained by purposive sampling. The results of the research showed that, simultaneously, company size, liquidity, profitability, leverage, company age, industry type, board of director, board of commissioner, audit committee and public ownership has an influence on the corporate social responsibility disclosure. Partially, the results showed that liquidity and leverage has an influence on the corporate social responsibility disclosure. Meanwhile, company size, profitability, company age, industry type, board of director, board of commissioner, audit committee and public ownership has no influence on corporate social responsibility disclosure.

Keywords: corporate social responsibility, CSR disclosure, Indonesia

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Authors: Ademuyiwa Agbonyin, Stamatis Zoras, Mohammad Zandi

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This paper investigates the extent to which building energy modelling can be informed based on preliminary information provided by infrared thermography using a thermal imaging camera in a walkthrough audit. The case-study building is the Sheffield Cathedral, built in the early 1400s. Based on an informative qualitative report generated from the thermal images taken at the site, the regions showing significant heat loss are input into a computer model of the cathedral within the integrated environmental solution (IES) virtual environment software which performs an energy simulation to determine quantitative heat losses through the building envelope. Building data such as material thermal properties and building plans are provided by the architects, Thomas Ford and Partners Ltd. The results of the modelling revealed the portions of the building with the highest heat loss and these aligned with those suggested by the thermal camera. Retrofit options for the building are also considered, however, may not see implementation due to a desire to conserve the architectural heritage of the building. Results show that thermal imaging in a walk-through audit serves as a useful guide for the energy modelling process. Hand calculations were also performed to serve as a 'control' to estimate losses, providing a second set of data points of comparison.

Keywords: historic buildings, energy retrofit, thermal comfort, software modelling, energy modelling

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Authors: Bassem Saleh, Hussam Nusair, Nariman Al Zubadi, Shams Al Shloul, Usama Saleh

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The nursing round system (NRS) means checking patients on an hourly basis during the A (0700–2200 h) shift and once every 2 h during the B (2200–0700 h) by the assigned nursing staff. The overall goal of this prospective study is to implement an NRS in a major rehabilitation centre—Sultan Bin Abdulaziz Humanitarian City—in the Riyadh area of the Kingdom of Saudi Arabia. The purposes of this study are to measure the effect of the NRS on: (i) the use of patient call light; (ii) the number of incidences of patients’ fall; (iii) the number of incidences of hospital-acquired bed sores; and (iv) the level of patients’ satisfaction. All patients hospitalized in the male stroke unit will be involved in this study. For the period of 8 weeks (17 December 2009–17 February 2010) All Nursing staff on the unit will record each call light and the patient’s need. Implementation of the NRS would start on 18 February 2010 and last for 8 weeks, until 18 April 2010. Data collected throughout this period will be compared with data collected during the 8 weeks period immediately preceding the implementation of the NRS (17 December 2009–17 February 2010) in order to measure the impact of the call light use. The following information were collected on all subjects involved in the study: (i) the Demographic Information Form; (ii) authors’ developed NRS Audit Form; (iii) Patient Call Light Audit Form; (iv) Patient Fall Audit Record; (v) Hospital-Acquired Bed Sores Audit Form; and (vi) hospital developed Patient Satisfaction Records. The findings suggested that a significant reduction on the use of call bell (P < 0.001), a significant reduction of fall incidence (P < 0.01) while pressure ulcer reduced by 50% before and after the implementation of NRS. In addition, the implementation of NRS increased patient satisfaction by 7/5 (P < 0.05).

Keywords: call light, patient-care management, patient safety, patient satisfaction, rounds

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Authors: Dalson Figueiredo, Enivaldo Rocha, Ranulfo Paranhos, José Alexandre

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This paper analyzes the effects of institutional capacity on corruption. Methodologically, the research design combines both descriptive and multivariate statistics to examine two original datasets based on secondary data. In particular, we employ a principal component model to estimate an indicator of institutional capacity for both state audit institutions and subnational judiciary courts. Then, we estimate the effect of institutional capacity on two dependent variables: (1) incidence of administrative irregularities and (2) time elapsed to judge corruption cases. The preliminary results using ordinary least squares, negative binomial and Tobit models suggest the same conclusions: higher the institutional audit capacity, higher is the probability of detecting a corruption case. On the other hand, higher the institutional capacity of state judiciary, the lower is the time to judge corruption cases.

Keywords: institutional capacity, corruption, state level institutions, evidence from Brazil

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Authors: Nur Imroatun Sholihat, Gresika Bunga Sylvana

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Currently, cyber attack became an incredibly serious problem due to its increasing trend all over the world. Therefore, information security becomes prominent for every organization including public sector organization. In Indonesia, unfortunately, Ministry of Finance (MoF) is the only public sector organization that has already formally established procedure to assess its information security adequacy by performing information security audits (November 2017). We assess the implementation of information security audits in the MoF using qualitative data obtained by interviewing IT auditors and by analysis of related documents. For this reason, information security audit practice in the MoF could become the acceptable benchmark for all other public sector organizations in Indonesia. This study is important because, to the best of the author’s knowledge, our research into information security audits practice in Indonesia’s public sector have not been found yet. Results showed that information security audits performed mostly by doing pentest (penetration testing) to MoF’s critical applications.

Keywords: information security audit, information technology, Ministry of Finance of Indonesia, public sector organization

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Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

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Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

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Authors: Asmaa Abazaid, Maram Al-Ostah, Nadeen Abu-Zahra, Ruba Bawab, Refaat Abdel-Razek

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Innovation audit is defined as a tool that can be used to reflect on how the innovation is managed in an organization. The aim of this study is to audit innovation in the second top Engineering Firms in the world, and one of the Small Medium Enterprises (SMEs) companies that are working in United Arab Emirates (UAE). The obtained results are then compared with four international companies from China and Brazil. The Diamond model has been used for auditing innovation in the two companies in UAE to evaluate their innovation management and to identify each company’s strengths and weaknesses from an innovation perspective. The results of the comparison between the two companies (Jacobs and Hyper General Contracting) revealed that Jacobs has support for innovation, its innovation processes are well managed, the company is committed to the development of its employees worldwide and the innovation system is flexible. Jacobs was doing best in all innovation management dimensions: strategy, process, organization, linkages and learning, while Hyper General Contracting did not score as Jacobs in any of the innovation dimensions. Furthermore, the audit results of both companies were compared with international companies to examine how well the two construction companies in UAE manage innovation relative to SABIC (Saudi company), Poly Easy and Arnious (Brazilian companies), Huagong tools and Guizohou Yibai (Chinese companies). The results revealed that Jacobs is doing best in learning and organization dimensions, while PolyEasy and Jacobs are equal in the linkage dimension. Huagong Tools scored the highest score in process dimension among all the compared companies. However, the highest score of strategy dimension was given to PolyEasy. On the other hand, Hyper General Contracting scored the lowest in all of the innovation management dimensions. It needs to improve its management of all the innovation management dimensions with special attention to be given to strategy, process, and linkage as they got scores below 4 out of 7 comparing with other dimensions. Jacobs scored the highest in three innovation management dimensions related to the six companies. However, the strategy dimension is considered low, and special attention is needed in this dimension.

Keywords: Brazil, China, innovation audit, innovation evaluation, innovation management, Saudi Arabia, United Arab Emirates

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Authors: Rachel Ashwell, Sally Millett

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Introduction: Adequate post-operative pain relief is a key priority in the delivery of caesarean sections. This improves patient experience, reduces morbidity and enables optimal mother-infant interaction. Recommendations outlined in the NICE guidelines for caesarean section (CS) include offering peri-operative intrathecal/epidural diamorphine and post-operative opioid analgesics; offering non-steroidal anti-inflammatory drugs (NSAIDs) unless contraindicated and taking hourly observations for 12 hours following intrathecal diamorphine. Method: This audit assessed the provision of post-CS analgesia in 29 women over a two-week period. Indicators used were the use of intrathecal/epidural opioids, use of post-operative opioids and NSAIDs, frequency of observations and patient satisfaction with pain management on post-operative days 1 and 2. Results: All women received intrathecal/epidural diamorphine, 97% were prescribed post-operative opioids and all were prescribed NSAIDs unless contraindicated. Hourly observations were not maintained for 12 hours following intrathecal diamorphine. 97% of women were satisfied with their pain management on post-operative day 1 whereas only 75% were satisfied on day 2. Discussion: This service meets the proposed standards for the provision of post-operative analgesia, achieving high levels of patient satisfaction 1 day after CS. However, patient satisfaction levels are significantly lower on post-operative day 2, which may be due to reduced frequency of observations. The lack of an official audit standard for patient satisfaction on postoperative day 2 may result in reduced incentive to prioritise pain management at this stage.

Keywords: Caesarean section, analgesia, postoperative care, patient satisfaction

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Authors: Daud Muhammad

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Introduction: Ankle radiographs are frequently requested in Emergency Departments (ED) for patients presenting with traumatic ankle pain. The Ottawa Ankle Rules (OAR) serve as a clinical guideline to determine the necessity of these radiographs, aiming to reduce unnecessary imaging. This audit was conducted to evaluate the adequacy of clinical information provided in radiograph requests in relation to the OAR. Methods: A retrospective analysis was performed on 50 consecutive ankle radiograph requests under ED clinicians' names for patients aged above 5 years, specifically excluding follow-up radiographs for known fractures. The study assessed whether the provided clinical information met the criteria outlined by the OAR. Results: The audit revealed that none of the 50 radiograph requests contained sufficient information to satisfy the Ottawa Ankle Rules. Furthermore, 10 out of the 50 radiographs (20%) identified fractures. Discussion: The findings indicate a significant lack of adherence to the OAR, suggesting potential overuse of radiography and unnecessary patient exposure to radiation. This non-compliance may also contribute to increased healthcare costs and resource utilization, as well as possible delays in diagnosis and treatment. Recommendations: To address these issues, the following recommendations are proposed: (1) Education and Training: Enhance awareness and training among ED clinicians regarding the OAR. (2) Standardised Request Forms: Implement changes to imaging request forms to mandate relevant information according to the OAR. (3) Scan Vetting: Promote awareness among radiographers to discuss the appropriateness of scan requests with clinicians. (4) Regular re-audits should be conducted to monitor improvements in compliance.

Keywords: Ottawa ankle rules, ankle radiographs, emergency department, traumatic pain

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Authors: Sammy Xiaoyan Ying

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Professional skepticism remains one of the most important and controversial topics in auditing. This study examines the influence of client cooperativeness and fraud risk on judgments of professional skepticism among Chinese entry-level auditors in the context of evaluation of client-provided audit evidence. Given that the essence of auditors’ PS rests on distrust of clients, this study invokes trust-related theories from psychological and cultural perspectives. Specifically, invoking psychology theories of trust concerning positive relationship between risk and distrust, this study hypothesizes that professional skepticism is likely to be positively associated with client fraud risk. The results support the hypothesis and show that lower (higher) levels of client fraud risk lead to lower (higher) levels of professional skepticism. Furthermore, drawing on analysis of relationship between cooperation and trust, with particular reference to guanxi dynamics in the Chinese culture, this study hypothesizes that professional skepticism is likely to be negatively associated with client cooperativeness. The results support the hypothesis and show that higher (lower) levels of client cooperativeness lead to lower (higher) levels of professional skepticism. The findings may assist audit firms and auditing educators in improving training and education programs and enhancing entry-level auditors’ abilities to maintain professional skepticism. Also, practitioners and regulators may benefit from increasing awareness of psychological factors in influencing professional skepticism.

Keywords: audit judgment, Chinese culture, entry-level auditor, professional skepticism

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Authors: Khadidja Mebarki, Naceur Boussouar, Nabila Ihaddadene, M. Akermi

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Food products are particularly sensitive, since they concern the health of the consumer, whether it’s be from the health point of view or commercial, this kind of product must be subjected to rigorous controls, in order to prevent any fraud. Quality and safety are essential for food security, public health and economic development. The strengthening of food security is essential to increase food security which is considered reached when all individuals can at any time access safe and nutritious food they need to lead healthy and active lives. The objective of this project is to initiate a quality approach in the laboratories of the quality control and the repression of fraud. It will be directed towards the application of good laboratory practices, traceability, management of quality documents (quality, procedures and specification manual) and quality audits. And to prepare the ground for a possible accreditation by ISO 17025 standard of BECHAR laboratory’s. The project will take place in four main stages: 1- Preparation of an audit grid; 2- Realization of a quality audit according to the method of 5 M completed by a section on quality documentation; 3- Drafting of an audit report and proposal for recommendations; 4- Implementation of corrective actions on the ground. This last step consisted in the formalization of the cleaning disinfection plan; work on good hygiene practices, establishment of a mapping of processes and flow charts of the different processes of the laboratory, classifying quality documents and formalizing the process of document management. During the period of the study within the laboratory, all facets of the work were almost appreciated, as we participated in the expertise performed in within it.

Keywords: quality, management, ISO 17025 accreditation, GLP

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Authors: Joana Gato, Ahmed Abotabekh, Panayoti Bachkangi

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Introduction: Oestrogen is an essential gonadal hormone that plays a vital role in the reproductive system of women1. The average age of menopause in the UK is 512. Women who go through premature menopause should be offered Hormone replacement therapy (HRT). Similarly, women who undergo surgical menopause should be offered HRT, unless contraindicated, depending on the indication of their surgery2,3. Aim: To assess if the patients in our department are counselled regarding HRT after surgical treatment and if HRT was prescribed. Methodology: A retrospective audit in a busy district hospital, examining all the patients who had a hysterectomy. The audit examined if HRT was discussed pre-operatively, prescribed on discharge and if a follow up was arranged. For women with contraindication to HRT, the audit assessed if the reasons were discussed pre-operatively and communicated to the Inclusion criteria: woman having a total or subtotal hysterectomy, with or without bilateral salpingo-ophorectomy (BSO), between April and September 2022. Exclusion criteria: woman having a vaginal hysterectomy. Results: 40 patients in total had hysterectomy; 27 (68%) were under the age of 51. 15 out of 27 patients bad BSO. 9 women were prescribed HRT, but 8 were offered HRT immediately, and 1 of them were offered a follow up. Of women who underwent surgical menopause, 7 were not given any HRT. The HRT choice was diverse, however, the majority was prescribed oral HRT. 40% of women undergoing surgical menopause did not have a discussion about HRT prior to their surgery. In postmenopausal women (n=13; 33%), still two were given HRT for preexisting menopausal symptoms. Discussion: Only 59% of the pre-menopausal patients had oophorectomy, therefore undergoing surgical menopause. Of these, 44% were not given any HRT, and 40% had no discussion about HRT prior to surgery. Interestingly, the majority of these women have no obvious contraindication to HRT. The choice of HRT was diverse, but the majority was commenced on oral HRT. Our unit is still working towards meeting all the NICE guidance standards of offering HRT and information prior to surgery to women planning to undergo surgical menopause. Conclusion: Starting HRT at the onset of menopause has been shown to improve quality of life and reduce the risk of cardiovascular disease and osteoporotic fractures4. Our unit still has scope for improvement to comply with the current NICE guidance. All pre-menopausal women undergoing surgical menopause should have a discussion regarding HRT prior to surgery and be offered it if there are no contraindications. This discussion should be clearly documented in the notes. At the time of this report, some of the patients have not yet had a follow up, which we recognize as a limitation to our audit.

Keywords: hormone replacement therapy, menopause, premature ovarian insufficiency, surgical management

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Authors: Ashana Gupta

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Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.

Keywords: botulinum toxin, aesthetics, handling, disposal

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Authors: Anita Blagojević

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It is well known that the terrorist attacks on the New York City and Washington, D.C. prompted unprecedented international action to enhance international cooperation in the prevention and suppression of terrorism. In the months (and years) after September 11, the world community focused on two main efforts: first, on efforts to bring those responsible for terrorist attacks to justice, and second, on efforts to prevent future terrorist attacks. In that sense, many governments took advantage of these efforts to strengthen their national security. In that process, however, human rights and civil liberties of certain groups of people were alleged. As a consequence, part of the price paid for protecting national security against terrorist attacks was the threat of infringement on people's fundamental rights and freedoms. The aim of this paper is to analyze the role of the European Union and the Council of Europe in finding the answer to the one of the main security dilemma for the present era: how to find the balance between the protection of national security and guarantee of the people's rights and fundamental freedoms?

Keywords: terrorism, antiterrorism, European Union, Council of Europe, human rights

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Authors: Asad Yousuf

Abstract:

Purpose: The aim of the present study was to audit treatment planning system beam dataset for small field output factors against standard dataset produced by radiological physics center (RPC) from a multicenter study. Such data are crucial for validity of special techniques, i.e., IMRT or stereotactic radiosurgery. Materials/Method: In this study, multiple small field size output factor datasets were measured and calculated for 6 to 18 MV x-ray beams using the RPC recommend methods. These beam datasets were measured at 10 cm depth for 10 × 10 cm2 to 2 × 2 cm2 field sizes, defined by collimator jaws at 100 cm. The measurements were made with a Landauer’s nanoDot OSLDs whose volume is small enough to gather a full ionization reading even for the 1×1 cm2 field size. At our institute the beam data including output factors have been commissioned at 5 cm depth with an SAD setup. For comparison with the RPC data, the output factors were converted to an SSD setup using tissue phantom ratios. SSD setup also enables coverage of the ion chamber in 2×2 cm2 field size. The measured output factors were also compared with those calculated by Eclipse™ treatment planning software. Result: The measured and calculated output factors are in agreement with RPC dataset within 1% and 4% respectively. The large discrepancies in TPS reflect the increased challenge in converting measured data into a commissioned beam model for very small fields. Conclusion: OSLDs are simple, durable, and accurate tool to verify doses that delivered using small photon beam fields down to a 1x1 cm2 field sizes. The study emphasizes that the treatment planning system should always be evaluated for small field out factors for the accurate dose delivery in clinical setting.

Keywords: small field dosimetry, optically stimulated luminescence, audit treatment, radiological physics center

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Authors: Ifedapo Francis Awolowo

Abstract:

The unrelenting series of embarrassing audit failures should stimulate a paradigm shift in accounting. And in this age of information revolution, there is need for a constant improvement on the products or services one offers to the market in order to be relevant. This study explores the perceptions of external auditors, forensic accountants and accounting academics on whether a paradigm shift to forensic accounting can reduce financial statement frauds. Through Neo-empiricism/inductive analytical approach, findings reveal that a paradigm shift to forensic accounting might be the right step in the right direction in order to increase the chances of fraud prevention and detection in the financial statement. This research has implication on accounting education on the need to incorporate forensic accounting into present day accounting curriculum. Accounting professional bodies, accounting standard setters and accounting firms all have roles to play in incorporating forensic accounting education into accounting curriculum. Particularly, there is need to alter the ISA 240 to make the prevention and detection of frauds the responsibilities of bot those charged with the management and governance of companies and statutory auditors.

Keywords: financial statement fraud, forensic accounting, fraud prevention and detection, auditing, audit expectation gap, corporate governance

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