Search results for: knowledge audit

Authors: Adam Aboalkaz, Rana Shamoon, Duncan Meikle, James Lewis

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Background and aims: In orthopaedic theatres, radiological screening during operations is a commonly used and useful technique to visualise and guide the operating surgeon. Within any theatre using ionising radiation, it is imperative that the use of protective equipment and the wearing of a dosimeter at all times. 1. To assess compliance with use of protective equipment during orthopaedic procedures involving ionising radiation. 2. To assess the radiation risk knowledge of staff members regularly present in an orthopaedic theatre of a national major trauma centre, in accordance to the ionising radiation regulation (2000) guidelines. Method: We conducted an Observational study of 21 operations at the University Hospital of Wales, which is a major trauma centre, recording the compliance with use of protective equipment (lead aprons and thyroid shields) and dosimeters. The observations were performed sporadically over a two week period to ensure that all staff in monitored operating theatres were not aware of the ongoing study, as to avoid bias. A questionnaire testing the knowledge of trainees and staff within the orthopaedic department was given following completion of the initial phase of the study, with 19 responses. The questions were based on knowledge of ionising radiation exposure and monitoring. The questions also tested the general staff knowledge of what equipment should be worn and where to locate such equipment. Results: This study found that only 25% of staff members were wearing thyroid protectors when less than 1 meter from the radiation source and only 50% were wearing appropriate lead aprons whilst in this same vicinity. The study also showed that 0% of all staff members used a dosimeter whilst in an area of radiation exposure. From the distributed questionnaires, only 40% of staff understood where to stand whilst radiation was being used, and only 25% of staff knew where to find protective equipment. Conclusion: Overall our audit showed poor compliance with regards to the National and local policies, due to lack of awareness of the policy and lack of basic ionising radiation exposure knowledge. It was evident from the observational study and questionnaire that staff were not fully aware of what equipment should be worn, where to find such equipment and did not appreciate that the distance from the ionising radiation source altered its exposure effect. This lack of knowledge may affect the staff health and safety after long term exposure. Changes to clinical practice: From the outcome of this study, we managed to drastically increase awareness of ionising radiation within the orthopaedic department. A mandatory teaching session on the safety of ionising radiation has been incorporated into the orthopaedic induction week for all staff. The dosimeters have been moved to a visible location within the trauma operating theatre and all staff made aware of where to find protective equipment.

Keywords: audit, ionising radiation, observational study, protection

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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: Shachi Pathak

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We are living in knowledge based economy where firms can gain competitive advantage with the help of managing knowledge within the organization. The purpose the study is to develop a conceptual model to explain the relationship between factors affecting knowledge sharing, called as knowledge enablers, in an organization, knowledge sharing activities and organizational performance, using system dynamics approach. This research is important since it will provide better understandings on what are the key knowledge enablers to support knowledge sharing activities, and how knowledge sharing activities will affect the capability of an organization to enhance the performance of the organization.

Keywords: knowledge management, knowledge sharing, organizational performance, system dynamics

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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: Jessica Gu, Yu Chen

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Knowledge Management (KM) is undoubtable crucial to organizational value creation, learning, and adaptation. Although the rapidly growing KM domain has been fueled with full-fledged methodologies and technologies, studies on KM evolution that bridge the organizational performance and adaptation to the organizational environment are still rarely attempted. In particular, creation (or generation) and diffusion (or share/exchange) of knowledge are of the organizational primary concerns on the problem-solving perspective, however, the optimized distribution of knowledge creation and diffusion endeavors are still unknown to knowledge workers. This research proposed an agent-based model of knowledge creation and diffusion in an organization, aiming at elucidating how the intertwining knowledge flows at microscopic level lead to optimized organizational performance at macroscopic level through evolution, and exploring what exogenous interventions by the policy maker and endogenous adjustments of the knowledge workers can better cope with different environmental conditions. With the developed model, a series of simulation experiments are conducted. Both long-term steady-state and time-dependent developmental results on organizational performance, network and structure, social interaction and learning among individuals, knowledge audit and stocktaking, and the likelihood of choosing knowledge creation and diffusion by the knowledge workers are obtained. One of the interesting findings reveals a non-monotonic phenomenon on organizational performance under turbulent environment while a monotonic phenomenon on organizational performance under a stable environment. Hence, whether the environmental condition is turbulence or stable, the most suitable exogenous KM policy and endogenous knowledge creation and diffusion choice adjustments can be identified for achieving the optimized organizational performance. Additional influential variables are further discussed and future work directions are finally elaborated. The proposed agent-based model generates evidence on how knowledge worker strategically allocates efforts on knowledge creation and diffusion, how the bottom-up interactions among individuals lead to emerged structure and optimized performance, and how environmental conditions bring in challenges to the organization system. Meanwhile, it serves as a roadmap and offers great macro and long-term insights to policy makers without interrupting the real organizational operation, sacrificing huge overhead cost, or introducing undesired panic to employees.

Keywords: knowledge creation, knowledge diffusion, agent-based modeling, organizational performance, decision making evolution

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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: Maram Saleh

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Knowledge has become an essential resource in today’s economy and become the most important asset of maintaining competition advantage in organizations. The importance of knowledge has made organizations to manage their knowledge assets and resources through all multiple knowledge management stages such as: Knowledge Creation, knowledge storage, knowledge sharing and knowledge use. Researches on data mining are continues growing over recent years on both business and educational fields. Data mining is one of the most important steps of the knowledge discovery in databases process aiming to extract implicit, unknown but useful knowledge and it is considered as significant subfield in knowledge management. Data miming have the great potential to help organizations to focus on extracting the most important information on their data warehouses. Data mining tools and techniques can predict future trends and behaviors, allowing businesses to make proactive, knowledge-driven decisions. This review paper explores the applications of data mining techniques in supporting knowledge management process as an effective knowledge discovery technique. In this paper, we identify the relationship between data mining and knowledge management, and then focus on introducing some application of date mining techniques in knowledge management for some real life domains.

Keywords: Data Mining, Knowledge management, Knowledge discovery, Knowledge creation.

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Authors: Gusa Hall, Barrie Keeler, Achal Khanna

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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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Authors: Javad Moghtader Kargaran

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Today, attention to knowledge and management Knowledge as a strategy is very important has taken with economy becoming knowledge-oriented, how and knowing the effective management and integration of different types Knowledge (obvious-implicit) to preserve and create advantage. Competition has become very important. Knowledge is a valuable resource for empowering organizations in the direction of innovation and competition. Due to the importance of human resources in the survival of organizations, extensive efforts are made to empower them. This knowledge can lead to awareness among employees. Employees and the knowledge that is in their minds are very valuable resources for the organization, which must be managed and developed. In fact, the ultimate goal of knowledge management is to increase the intelligence and productivity of employees and the organization.

Keywords: knowledge, management, productivity, human

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Authors: Delio I. Castaneda, Paul Toulson

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The purpose of this study was to investigate the knowledge sharing effectiveness of two types of knowledge, tacit and explicit, depending on two channels: face to face or digital. Participants were 217 knowledge workers in New Zealand and researchers who attended a knowledge management conference in the United Kingdom. In the study, it was found that digital tools are effective to share explicit knowledge. In addition, digital tools that facilitated dialogue were effective to share tacit knowledge. It was also found that face to face communication was an effective way to share tacit and explicit knowledge. Results of this study contribute to clarify in what cases digital tools are effective to share tacit knowledge. Additionally, even though explicit knowledge can be easily shared using digital tools, this type of knowledge is also possible to be shared through dialogue. Result of this study may support practitioners to redesign programs and activities based on knowledge sharing to make strategies more effective.

Keywords: digital knowledge, explicit knowledge, knowledge sharing, tacit knowledge

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Authors: Mehrnoosh Askarizadeh

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The customer’s value has become obvious for the leading companies in today’s competitive environment. Therefore they are constantly trying to improve their relationship with customers. Customer Knowledge has been recognized as a strategic resource and a key to the success of any company. Talking about the Customer Knowledge Management is closely associated with Knowledge Management and Customer Relationship Management (CRM). Recent studies conducted in the fields of Knowledge Management (KM) and Customer Relationship Management (CRM) has explained that the two approaches can have great synergies. In this paper, our aim is to provide an understanding of Customer Knowledge Management (CKM) as an integrated management approach and competence it requires. We describe CKM as an ongoing process of generating, disseminating and using customer knowledge within an organization and between an organization and its customers. In addition, we propose a comprehensive framework of CKM, the ability to integrate customer knowledge into customer relationship management processes.

Keywords: e-commerce, knowledge management (KM), customer relationship management (CRM), customer knowledge management (CKM)

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Authors: M. Erhan Orhan, Onur Ozdemir

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Expansion of area of operation and increasing diversity of threats forced the military organizations to change in many ways. However, tacit knowledge still is the most fundamental component of organizational knowledge. Since it is human oriented and in warfare human stands at the core of the organization. Therefore, military organizations should find effective ways of systematically utilizing tacit knowledge. In this context, this article suggest some methods for turning tacit knowledge into explicit in military organizations.

Keywords: tacit knowledge, military, knowledge management, warfare, technology

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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: Asish O. Mathew, Lewlyn L. R. Rodrigues

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The organizations in the knowledge economy era have recognized the importance of building knowledge assets for sustainable growth and development. In comparison to other industries, Information Technology (IT) enterprises, holds an edge in developing an effective Knowledge Management (KM) program, thanks to their in-house technological abilities. This paper tries to study the various knowledge-based incentive programs and its effect on Knowledge Sharing and Learning in the context of the Indian IT sector. A conceptual model is developed linking KM incentives, knowledge sharing, and learning. A questionnaire study is conducted to collect primary data from the knowledge workers of the IT organizations located in India. The data was analysed using Structural Equation Modeling using Partial Least Square method. The results show a strong influence of knowledge management incentives on knowledge sharing and an indirect influence on learning.

Keywords: knowledge management, knowledge management incentives, knowledge sharing, learning

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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: Chihab Benmoussa

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Could the Work System Approach (WSA) function as a framework for designing high-impact knowledge mobilization systems? This paper put forward arguments in favor of the applicability of WSA for knowledge mobilization design based on evidences from a practical research. Normative approaches for practitioners are highly needed especially in the field of knowledge management (KM), given the abysmal rate of disappointment and failure of KM projects. The paper contrasts knowledge management and knowledge mobilization, presents the WSA and showed how the WSA’s concepts and ideas fit with the approach adopted by a multinational company in designing a successful knowledge mobilization initiative.

Keywords: knowledge management, knowledge mobilizations, work system method

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Authors: Desmond Chinedu Oparaku, Pearl C. Akanwa, Oyemike Victor Benson

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This paper examines the challenges facing library and information centers (LICs) in managing indigenous knowledge in academic libraries in developing countries. The need for managing an indigenous knowledge in library and information centers in developing nations is becoming more critical. There is an ever increasing output of indigenous knowledge; effective management of indigenous knowledge becomes necessary to enable the next generation benefit from them. This paper thus explores the concept of indigenous knowledge (IK), nature of indigenous knowledge (IK), the various forms of indigenous knowledge (IK), sources of indigenous knowledge (IK), and relevance of indigenous knowledge (IK). The expectations of library and information professionals towards effective management of indigenous knowledge and the challenges to effective management of indigenous knowledge were highlighted. Recommendations were made based on the identified challenges.

Keywords: library, indigenous knowledge, information centres, information professionals

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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: Alexander Denzler, Marcel Wehrle, Andreas Meier

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A knowledge base stores facts and rules about the world that applications can use for the purpose of reasoning. By applying the concept of granular computing to a knowledge base, several advantages emerge. These can be harnessed by applications to improve their capabilities and performance. In this paper, the concept behind such a construct, called a granular knowledge cube, is defined, and its intended use as an instrument that manages to cope with different data types and detect knowledge domains is elaborated. Furthermore, the underlying architecture, consisting of the three layers of the storing, representing, and structuring of knowledge, is described. Finally, benefits as well as challenges of deploying it are listed alongside application types that could profit from having such an enhanced knowledge base.

Keywords: granular computing, granular knowledge, hierarchical structuring, knowledge bases

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Authors: Ahmad Aslizadeh, Farid Ghaderi

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Mapping organizational knowledge is an innovative concept and useful instrument of representation, capturing and visualization of implicit and explicit knowledge. There are a diversity of methods, instruments and techniques presented by different researchers following mapping organizational knowledge to reach determined goals. Implicating of these methods, it is necessary to know their exigencies and conditions in which those can be used. Integrating identified methods of knowledge mapping and comparing them would help knowledge managers to select the appropriate methods. This research conducted to presenting a model and framework to map organizational knowledge. At first, knowledge maps, their applications and necessity are introduced because of extracting comparative framework and detection of their structure. At the next step techniques of researchers such as Eppler, Kim, Egbu, Tandukar and Ebner as knowledge mapping models are presented and surveyed. Finally, they compare and a superior model would be introduced.

Keywords: knowledge mapping, knowledge management, comparative study, business and management

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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: A. Amidah Amrawaty, M. Saleh S. Ali, Darmawan Salman

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The aim of this study was to identify local and non local knowledge in Bali cattle development, to analyze the contestation between local and non-local knowledge. The paradigm used was constructivism paradigm with a qualitative approach. descriptive type of research using case study method. The study was conducted in four villages subjected to Agropolitan Program, i.e. Palakka, Tompo, Galung and Anabanua in Barru District, province of South Sulawesi. The results indicated that the local knowledge of the farmers were: a) knowledge of animal housing, b) knowledge of the prevention and control disease, c) knowledge of the feed, d) knowledge of breed selection, e) knowledge of sharing arrangement, f) knowledge of marketing, Generally, there are three patterns of knowledge contestation namely coexistence, ‘zero sum game’ and hybridization but in this research only coexistence and zero sum game patterns took place, while the pattern of hybridization did not occur.

Keywords: contestation, local knowledge, non-local knowledge, developing of Bali cattle

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Authors: Deepa Kapoor, Rajshree Singh

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This paper appreciates the emergence and growing importance as a new production factor makes the development of technologies, methodologies and strategies for measurement, creation, and diffusion into one of the main priorities of the organizations in the knowledge society. There are many models for creation and management of knowledge and diverse and varied perspectives for study, analysis, and understanding. In this article, we will conduct a theoretical approach to the type of models for the creation and management of knowledge; we will discuss some of them and see some of the difficulties and the key factors that determine the success of the processes for the creation and management of knowledge.

Keywords: knowledge creation, knowledge management, organizational development, organization learning

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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: Prabhakar Venugopal G.

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Complex environments triggered by globalization have necessitated new paradigms of leadership – complexity leadership that encompasses multiple roles that leaders need to take upon. The success of higher education institutions depends on how well leaders can provide adaptive, administrative and enabling leadership. Complexity leadership seems all the more relevant for institutions that are knowledge-driven and thrive on knowledge creation, knowledge storage and retrieval, knowledge sharing and knowledge applications. In this paper are the elements of globalization, the opportunities and challenges that are brought forth by globalization are discussed. The complexity leadership paradigm in a knowledge-based economy and the need for such a paradigm shift for higher education institutions is presented. Further, the paper also discusses the support the leader requires in a knowledge-driven economy through knowledge management initiatives.

Keywords: globalization, complexity leadership, knowledge management

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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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