Search results for: audit committee

Authors: Joshua Abraham, Craig Wales

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Abstract—SIGN Guideline 122 recommends that all patients who are admitted to hospital are assessed for venous thromboembolism risk within 24 hours of admission. NHS Greater Glasgow and Clyde provide guidance on this in the form of a proforma. Patients are then subsequently prescribed either thrombo-embolic-deterrent stockings (TEDS)/low molecular weight heparin (LMWH) for the prevention of VTE based on their score. A retrospective casenote audit of a random sample of fifty oncology and trauma inpatients at the QEUH in December 2019 was performed. 90% of patients had a risk assessment conducted as evidenced by a completed proforma. In 78% of these patients, the proforma fully completed. Overall 94% of patients had some for of thromboprophylaxis prescribed in the form of TEDS or LMWH. A lack of 100% compliance against the given standards highlighted potential implications for patient safety, but also medico-legal ramifications for staff. Clinical judgement can only be relied upon if there is written documentation as evidence. Further staff education and the suggestion of a written prompt to the clerk-in documentation will hopefully improve compliance, whilst a repeat audit should demonstrate any improvement.

Keywords: Maxillofacial , Thromboembolism, Thromboprophylaxis , Prescription

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Tooraj Karimi, Mohammadreza Sadeghi Moghadam

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Grey set theory has the advantage of using fewer data to analyze many factors, and it is therefore more appropriate for system study rather than traditional statistical regression which require massive data, normal distribution in the data and few variant factors. So, in this paper grey clustering and entropy of coefficient vector of grey evaluations are used to analyze energy consumption in buildings of the Oil Ministry in Tehran. In fact, this article intends to analyze the results of energy audit reports and defines most favorable characteristics of system, which is energy consumption of buildings, and most favorable factors affecting these characteristics in order to modify and improve them. According to the results of the model, ‘the real Building Load Coefficient’ has been selected as the most important system characteristic and ‘uncontrolled area of the building’ has been diagnosed as the most favorable factor which has the greatest effect on energy consumption of building. Grey clustering in this study has been used for two purposes: First, all the variables of building relate to energy audit cluster in two main groups of indicators and the number of variables is reduced. Second, grey clustering with variable weights has been used to classify all buildings in three categories named ‘no standard deviation’, ‘low standard deviation’ and ‘non- standard’. Entropy of coefficient vector of Grey evaluations is calculated to investigate greyness of results. It shows that among the 38 buildings surveyed in terms of energy consumption, 3 cases are in standard group, 24 cases are in ‘low standard deviation’ group and 11 buildings are completely non-standard. In addition, clustering greyness of 13 buildings is less than 0.5 and average uncertainly of clustering results is 66%.

Keywords: energy audit, grey set theory, grey incidence matrixes, grey clustering, Iran oil ministry

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Authors: Henriette Scholtz

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Excessive executive directors’ remuneration remains a major concern for many stakeholders and are some of the factors to blame for the recent global financial crisis. The objective of this study was to examine whether certain firm characteristics are an effective way of protecting shareholders’ interests with respect to executive directors’ remuneration. To achieve this, an ordinary least squares model was used to test the relationship between the remuneration of executive directors and a number of firm and corporate governance characteristics to determine whether these characteristics have an influence on executive directors’ remuneration of large listed companies in South Africa. It was found that corporate governance reforms relating to institutional ownership, shareholder voting on the remuneration policy and the number of remuneration committee meetings acts as an effective governance tool to protect shareholder’s interests with regard to executive remuneration. There is no evidence that the number of non-executive directors on the remuneration committee has an influence on the executive directors’ remuneration.

Keywords: executive directors’ remuneration, agency theory, corporate governance, remuneration committee, directors’ shareholding, institutional ownership

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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: 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: 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: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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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: 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: Mohammad Noor Hisham Osman, Ahmed Razman Abdul Latiff, Zaidi Mat Daud, Zulkarnain Muhamad Sori

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The problem that Malaysian auditors do not issue going concern opinion (GC opinion) to seriously financially distressed companies is still a pressing issue. Policy makers, particularly the Financial Statement Review Committee (FSRC) of Malaysian Institute of Accountant, have raised this issue as early as in 2009. Similar problem happened in the US, UK, and many developing countries. It is important for auditors to issue GC opinion properly because such opinion is one signal about the viability of a company much needed by stakeholders. There are at least two unanswered questions or research gaps in the literature on determinants of GC opinion. Firstly, is client’s probability of failure associated with GC opinion issuance? Secondly, to what extent influential owners (management, family, and institution) moderate the association between client probability of failure and GC opinion issuance. The objective of this study is, therefore, twofold; (1) To examine the extent of the relationship between the probability of client failure and the issuance of GC opinion and (2) To examine the level of management, family, and institutional ownerships moderate the association between client probability of failure and the issuance of GC opinion. This study is quantitative in nature, and the sources of data are secondary (mainly company’s annual reports). A total of four hypotheses have been developed and tested on data accumulated from annual reports of seriously financially distressed Malaysian public listed companies. Data from 2006 to 2012 on a sample of 644 observations have been analyzed using panel logistic regression. It is found that certainty (rather than probability) of client failure affects the issuance of GC opinion. In addition, it is found that only the level of family ownership does positively moderate the relationship between client probability of failure and GC opinion issuance. This study is a contribution to auditing literature as its findings can enhance our understanding about audit quality; particularly on the variables that are associated with the issuance of GC opinion. The findings of this study shed light on the roles family owners in GC opinion issuance process, and this would open ways for the researcher to suggest measures that can be used to tackle the problem of auditors do not want to issue GC opinion to financially distressed clients. The measures to be suggested can be useful to policy makers in formulating future promulgations.

Keywords: audit quality, auditing, auditor characteristics, going concern opinion, Malaysia

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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: Alon Cohen, Jeffrey Kantor, Shalom Levy

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The use of the audit risk model in auditing has faced limitations and difficulties, leading auditors to rely on a conceptual level of its application. The qualitative approach to assessing risks has resulted in different risk assessments, affecting the quality of audits and decision-making on the adoption of CAATTs. This study aims to investigate risk factors impacting the implementation of the audit risk model and propose a complementary risk-based instrument (KRIs) to form substance risk judgments and mitigate against heightened risk of material misstatement (RMM). The study addresses the question of how risk factors impact the implementation of the audit risk model, improve risk judgments, and aid in the adoption of CAATTs. The study uses a three-stage scale development procedure involving a pretest and subsequent study with two independent samples. The pretest involves an exploratory factor analysis, while the subsequent study employs confirmatory factor analysis for construct validation. Additionally, the authors test the ability of the KRIs to predict audit efforts needed to mitigate against heightened RMM. Data was collected through two independent samples involving 767 participants. The collected data was analyzed using exploratory factor analysis and confirmatory factor analysis to assess scale validity and construct validation. The suggested KRIs, comprising two risk components and seventeen risk items, are found to have high predictive power in determining audit efforts needed to reduce RMM. The study validates the suggested KRIs as an effective instrument for risk assessment and decision-making on the adoption of CAATTs. This study contributes to the existing literature by implementing a holistic approach to risk assessment and providing a quantitative expression of assessed risks. It bridges the gap between intuitive risk evaluation and the theoretical domain, clarifying the mechanism of risk assessments. It also helps improve the uniformity and quality of risk assessments, aiding audit standard-setters in issuing updated guidelines on CAATT adoption. A few limitations and recommendations for future research should be mentioned. First, the process of developing the scale was conducted in the Israeli auditing market, which follows the International Standards on Auditing (ISAs). Although ISAs are adopted in European countries, for greater generalization, future studies could focus on other countries that adopt additional or local auditing standards. Second, this study revealed risk factors that have a material impact on the assessed risk. However, there could be additional risk factors that influence the assessment of the RMM. Therefore, future research could investigate other risk segments, such as operational and financial risks, to bring a broader generalizability to our results. Third, although the sample size in this study fits acceptable scale development procedures and enables drawing conclusions from the body of research, future research may develop standardized measures based on larger samples to reduce the generation of equivocal results and suggest an extended risk model.

Keywords: audit risk model, audit efforts, CAATTs adoption, key risk indicators, sustainability

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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: Tebeu Pierre Marie

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Introduction: WHO defines community participation as a process in which the local population, take responsibility in planning for their health, participates in the strategy’s development for implementation and accessibility to physical, moral and social well-being. For the purpose of dealing with health, the community participation is made through the organization called health Centre committee leader (HCCL/COSA) for Integrated health Center and District hospital committee leaser (HDCL/COGES) for District Hospital. Little is known about the effective participation of the community in health related activities in Ignié-Ngabé-Mayama health district. Objective: This study aimed at assessing the involvement of community in the health system running at the Ignié-Ngabé-Mayama health district. Methods: This was a qualitative cross-sectional study conducted in the Ignié-Ngabé-Mayama health district from 15 December 2020 to 30 April 2021. The study population consisted of 10 HCCL and one District hospital committee leaser (DHCL). Data were collected using a pretested questionnaire and validated by the investigating team. The variables of interest were; effective existence of HCCL/DHCL, their involvement HCCL/DHCL in health related activities, their financing management, planning of activities and leadership. Results: A total of 11 participants were interviewed, including 10 HCCL and 1 DHCL. The Sex-Ratio was 9/11; with primary level 6/11 and were mostly farmers 6/11. Analyzing the involvement of the HDCL/DHCL in health promotion and preventive activities; this was effective only for two of them (2/11). Analyzing the barriers for their involvement, the leaders reported the lack of financial support by the state, lack NGO support. Additionally, they reported to have been very active when there was Performance Based Founding Project in the District. Conclusion: Only two of the (HDCL/HCCL) out of 11 were really functioning. Reported barriers to their running were: lack of state/NGOs support and ending of PBF Project. There is a need to organize a tripartite forum including stats, NGOs and Community for boosting the community participation in health related activities in Ignié-Ngabé-Mayama health district.

Keywords: health district committee, health Centre committee, community participation, Brazzaville, Congo

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Authors: Samir Srairi

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This paper investigates the impact of the internal corporate governance on bank performance by constructing a corporate governance index (CGI) for 27 Islamic banks operating in five Arab Gulf countries. Using content analysis on the banks’ annual reports for 3 years (2011-2013), the index construction uses information on six important corporate governance mechanisms, namely board structure, risk management, transparency and disclosure, audit committee, Sharia supervisory board and investment account holders. The results demonstrate that Islamic banks adhere to 54% of the attributes addressed in the CGI. The most frequently reported and disclosed elements are Sharia supervisory board followed by board structure and risk management. The findings related to countries revealed that only two countries, the United Arab Emirates and Bahrain, possess a higher level of CGI. Our regression results provide evidence that Islamic banks with higher levels of corporate governance report high operating performance measured by return on assets and net interest margin. Finally, as of the effect of internal and external factors, we identified four variables that were associated with bank performance, namely size, equity, risk and concentration.

Keywords: governance mechanisms, corporate governance index, bank performance, Islamic banks, GCC countries

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Authors: Idris Adamu Alhaji, Wan Fauziahbt Wan Yusoff

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This study was conducted to identify the relationship between Corporate Governance attributes and Firm Performance, various studies, had been carried out mostly in developed countries, in order to identify the relationship between corporate governance attributes and firm performance. Since, the value creation of corporate governance can be measured through the firm performance, corporate governance act as a mechanism to align management's goals with the stakeholders especially to increase firm performance. Despite extensive study of corporate governance there is still an inconsistence relationship between corporate governance attributes and firm performance. Therefore, the aim of this paper is to identify the relationship between corporate governance attributes and firm performance. Five corporate governance element were used as independent variables which include: Independent director, board size, audit committee, leadership structure and board meeting. Meanwhile, the dependent variables are two firm performance measurements; return on equity (ROE) and earning per share (EPS). This study uses quantitative approaches whereby data were gathered from secondary source data were collected from Annual Reports of the companies, online journals etc. This study revealed that, there is a significant relationship between corporate governance attributes and firm performance. Therefore, the results show that good corporate governance practice influence firm performance. Finally, it's hoped that this study provides current corporate governance scenario in Malaysia that can be used to enhance the development of corporate governance of the country.

Keywords: corporate governance, return on equity, earning per share, financial performance

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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: Petra F. A. Dilling, Sinan Caykoylu

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The aim of this study was to shed light on the understanding of the factors determining a company’s disclosure on climate change reporting. The underlying study examines the effect of gender diversity and the mediating effect of female representation in management and on the board of directors and the existence of a dedicated sustainability board committee. To test the study’s objectives, the authors use a global sample of the largest companies and their reporting for the year 2020. The results suggest that corporate female participation has a significant influence on the quality of climate change reporting. In addition, having a dedicated sustainability board committee also significantly impacts the non-financial disclosure of climate change information.

Keywords: climate change, non-financial reporting, governance, board diversity, sustainability, CSR

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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: Hani Alkayed, Belal Omar, Eileen Roddy

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This study focuses on investigating the determinants of Corporate Social Responsibility Disclosure (CSRD) extent and quality in Jordan. The study examines factors that influence CSR disclosure extent and quality, such as corporate characteristics (size, gearing, firm’s age, and industry type), corporate governance (board size, number of meetings, non-executive directors, female directors in the board, family directors in the board, foreign members, audit committee, type of external auditors, and CEO duality) and ownership structure (government ownership, institutional ownership, and ownership concentration). Legitimacy theory is utilised as the main theory for our theoretical framework. A quantitative approach is adopted for this research and content analysis technique is used to gather CSR disclosure extent and quality from the annual reports. The sample is withdrawn from the annual reports of 118 Jordanian companies over the period of 2010-2015. A CSRD index is constructed, and includes the disclosures of the following categories; environmental, human resources, product and consumers, and community involvement. A 7 point-scale measurement was developed to examine the quality of disclosure, were 0= No Disclosures, 1= General disclosures, (Non-monetary), 2= General disclosures, (Non-monetary) with pictures, charts, and graphs 3= Descriptive/ qualitative disclosures, specific details (Non-monetary), 4= Descriptive/ qualitative disclosures, specific details with pictures, charts, and graphs, 5= Numeric disclosures, full descriptions with supporting numbers, 6= Numeric disclosures, full descriptions with supporting numbers, pictures, and Charts. This study fills the gap in the literature regarding CSRD in Jordan, and the fact that all the previous studies have ignored a clear categorisation as a measurement of quality. The result shows that the extent of CSRD is higher than the quality in Jordan. Regarding the determinants of CSR disclosures, the followings were found to have a significant relationship with both extent and quality of CSRD except non-executives, were the significant relationship was found just with the extent of CSRD: board size, non-executive directors, firm’s age, foreign members on the board, number of boards meetings, the presence of audit committees, big 4, government ownership, firm’s size, industry type.

Keywords: content analysis, corporate governance, corporate social responsibility disclosure, Jordan, quality of disclosure

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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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