Examining characteristics of those who receive pedorthic services: A clinical audit.

Diabetes-related foot complications, including neuropathic plantar forefoot ulcers, are a significant contributor to morbidity and increased healthcare costs. This retrospective clinical audit examines the characteristics of people accessing pedorthics services who are at risk of neuropathic plantar forefoot ulcer (re)occurrence and the pathways and funding models used to access these services. A clinical record audit was conducted on all patients accessing a pedorthics service who had diabetes and neuropathy with a history of plantar forefoot ulceration. The data included demographics, diabetes and neuropathy duration, main forefoot pathology and other comorbidity, footwear and insole interventions, and health fund access status. A total of 70 patient records were accessed, and relevant data was extracted. The mean age of participants was 64.69 (standard deviation (SD) 11.78) years; 61% were male and 39% female. Duration of diabetes ranged from one to 35 years, with a mean of 14.09 years (SD 6.58). The mean duration of neuropathy was 8.56 (SD 4.16) years. The most common forefoot conditions were bony prominences at 71% (n = 50), rigid flat foot and limited joint mobility (53%, n = 37), and hallux abductovalgus at 47% (n = 33). All participants had hyperkeratosis; 34% (n = 24) had forefoot amputation, and around 34% (n = 24) had a history of digital amputation. Various publicly funded packages and private health insurance were accessed. This study investigates the sociodemographic and medical profiles of individuals with diabetes-related foot complexities prone to neuropathic plantar forefoot ulcers. It is the first to examine patients receiving pedorthic services, informing practitioner surveys and preventive care strategies. Understanding patient characteristics aids in optimising multidisciplinary care and reducing ulcer incidence. Further studies are warranted to explore the field to establish an effective multidisciplinary care approach between medical professionals, podiatrists and pedorthists to optimise patient outcomes.

Clinical audit of the image quality and customised contrast volume using P3T contrast injection software versus standard injection protocol in CT coronary angiography.

INTRODUCTION: The implications of shorter scan time and lower tube voltage in the dual-source CT coronary angiography (CTCA) scan protocol necessitate the adaptation of contrast media (CM) injection parameters. This audit evaluates the coronary arteries' vascular attenuation and image quality by comparing the personalised patient protocol technology (P3T) contrast injection software with standard injection protocol. The secondary aim is to determine the relationship between CM volume and the patient's weight. METHODOLOGY: A Siemens Somatom Definition Force CT Unit was used to scan 30 sets of patients between August 2020 and October 2020. Patients were selected retrospectively and separated into Standard Injection and P3T injection protocols. An experienced radiologist blinded to the groups reviewed the coronary vessels' contrast enhancement and image quality. RESULTS: Overall, the mean HU of all the main coronary artery vessels obtained from P3T injection software reached above 350 HU and was diagnostically sufficient. The mean attenuation at the proximal region of RCA in the 80-99 kg weight category was significantly higher in the P3T injection software than the standard injection protocol (p < 0.001). The CM volume proposed by P3T injection software for 40-59 kg was approximately 57 ± 5 mls, while 75 ml was used for the standard injection protocol. CONCLUSION: P3T injection software in CTCA resulted in an adequate diagnostic attenuation of coronary arteries (>350HU) in all weight groups, most effectively in the higher weight group, while maintaining diagnostic image quality. Further, the P3T software reduces CM volumes in lower-weight patients. IMPLICATIONS: P3T software enables reducing CM volume in lower-weight patients while improving vascular enhancement in CTCA scans in higher-weight patients.

Clinical Audit of Papillary Thyroid Cancer Reporting Format in Sultan Qaboos University Hospital in Oman.

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Characterisation of young stroke presentations, pathways of care, and support for 'invisible' difficulties: a retrospective clinical audit study.

Background Young stroke survivors are likely to be discharged home from acute hospital care without rehabilitation more quickly than older survivors, but it is not clear why. File-audit studies capturing real-world clinical practice are lacking for this cohort. We aimed to compare characteristics and care pathways of young and older survivors and describe stroke presentations and predictors of pathways of care in young survivors (≤45years), including a focus on care received for 'invisible' (cognitive, psychological) difficulties. Methods A retrospective audit of 847 medical records (67 young stroke survivors, mean age=36years; 780 older patients, mean age=70years) was completed for stroke survivors admitted to an Australian tertiary hospital. Stroke characteristics and presence of cognitive difficulties (identified through clinician opinion or cognitive screening) were used to predict length of stay and discharge destination in young stroke survivors. Results There were no differences in length of stay between young and older survivors, however, young stroke survivors were more likely to be discharged home without rehabilitation (though this may be due to milder strokes observed in young stroke survivors). For young stroke survivors, stroke severity and age predicted discharge destination, while cognitive difficulties predicted longer length of stay. While almost all young survivors were offered occupational therapy and physiotherapy, none received psychological input (clinical, health or neuropsychology). Conclusions Cognitive and psychological needs of young stroke survivors may remain largely unmet by a service model designed for older people. Findings can inform service development or models of care, such as the new Australian Young Stroke Service designed to better meet the needs of young survivors.

Current practice of pre-operative assessment at a public sector hospital in Pakistan - a clinical audit.

Objective: To assess the practice of ordering unnecessary laboratory investigations by primary surgical teams. METHODS: The clinical audit was conducted from December 17, 2022, to January 15, 2023, at the Civil Hospital, Karachi, and comprised primary surgeons working in different surgical units who ordered laboratory investigations for patients as a part of preoperative assessment. Data was collected using a self-administered questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 280 surgeons approached, 249(89%) responded. The units covered were General surgery 96(38.5%), Gynaecology 74(29.7%), Neurosurgery 5(2.0%), Ear, Nose and Throat 19(7.6%), Plastic surgery 15(6.02%), Paediatric surgery 13(5.2%), Vascular surgery 8(3.21%), Oromaxilofacial 9(3.61%), Opthalmology 6(2.4%), and Orthopaedics 4(1.60%).As part of baseline investigations, 244(98%) surgeons ordered complete blood count, 173(69.5%) ordered urea and creatinine, 229(92%) ordered viral markers, 197(78.7%) ordered fasting and random blood glucose, and 178(71.5%) focussed on cardiac fitness. Conclusion: A need was found to establish standard protocols for pre-surgery evaluation so that unnecessary investigations may be avoided.

Preoperative investigation practices for elective surgical patients: clinical audit.

BACKGROUND: The findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient's history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE). METHODS: This three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013. RESULTS: During the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations. CONCLUSIONS: In our hospital's surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery.

A clinical audit in a UK-based acupuncture private practice: assessing patient demographics, outcomes and experience.

OBJECTIVES: The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. METHODS: Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. RESULTS: Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1-4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = -0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. CONCLUSIONS: Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements.

Management of acute sexual assault presenting to a large Australian sexual health clinic in 2012-2021: a retrospective clinical audit.

Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.

Évaluation du processus d'annonce de diagnostic de trouble de personnalité état-limite : audit clinique dans un service ambulatoire pour jeunes adultes.

INTRODUCTION: Borderline personality disorder is a commonly encountered disorder in psychiatry. This diagnosis is rarely given despite the benefits of its disclosure. Recommendations concerning diagnosis disclosure in psychiatry have recently been published. An analysis of the disclosure process in an outpatient team for young adults enables the identification of areas for improvement in this process, as well as nursing actions to facilitate health-illness transitions. METHOD: A clinical audit was conducted through a study involving a retrospective quantitative section based on an analysis of the computerized patient file and a qualitative section based on interviews with the team’s nurses. RESULTS: Of the 11 cases included, none met all 16 quality criteria. The patient’s abilities were taken into consideration in 100% of cases. The criteria concerning the presence of the patient’s family were rarely respected. The nurses’ own skills made it easier to support the patient during the diagnosis announcement. DISCUSSION: Conflicts between the patient and their family explain the difficulties encountered. The nursing actions carried out in this process are in line with those proposed by Meleis in her transitions theory. The actions proposed to improve practices will have to be evaluated.

A clinical audit of the Emergency Department: Doctors' opinions on the diagnosis and management of cervical spine radiculopathy.

OBJECTIVE: A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. METHOD: Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. RESULTS: Most agreed that CSR will improve within 4 weeks with non-operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. CONCLUSION: Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management.

Men after the sexual assault: The journey from medical service to court.

BACKGROUND: There may be significant physical and psychological consequences and impacts for males who experience sexual assault as adults, however, published literature in this context is sparse, specifically for the investigative outcomes in the criminal legal process. METHOD: This clinical audit tracked 138 adult males who presented for forensic and medical sexual assault care from initial presentation to ACT Police investigation and court outcome from 2004 to 2022. RESULTS: There were 103/138 (74.6%) males who attended for medical and forensic care within 72 h of the reported assault. Pre-existing mental health conditions were self-reported in 59/138 (42.7%) males. Nearly half of males 67/138 (48.5%) had a medical evidence kit collected. Males presenting for medical care 44/138 (31.2%) went on to report to ACT Policing, 36/44 (81.2%) of cases did not proceed to court. The most common clearance type was inadequate evidence to proceed (17/44, 38.6%). In 8/44 (18.2%) of adult male cases who subsequently reported to ACT Police, the investigation resulted in entry to the judicial process with a suspect charged with a sexual offence. Five of those cases resulting in a conviction. CONCLUSIONS: Many adult male patients presented within timeframes that enabled the provision of time critical medical care and provided an opportunity for forensic medical evidence collection. Many adult males 59 (42.7%) self-reported pre-existing mental health conditions upon initial presentation. Attrition occurred throughout the patient journey with many males not reporting to police and thus not presenting in the legal process. This further emphasises the need for independent sexual violence patient advisors to support adult male victims through the medical and criminal justice process.

General practitioner prescription patterns for atopic eczema in children-Are they affected by telemedicine advice?

Traditionally, patients presenting to primary care with severe eczema would be referred to a dermatology clinic for an in-person specialist appointment. With the rise of teledermatology, dermatologists are instead dispensing tailored written advice based on information provided in the referral. However, there is currently minimal literature assessing whether this advice translates into relevant prescriptions. This clinical audit examines GP prescribing practices and how they correlate to dermatologist recommendations with the objective of assessing whether this form of teledermatology is a viable method of providing care to paediatric eczema patients.

[National confidential enquiry into maternal deaths in France, a 25-year enhanced surveillance system, essential for the reliable characterization of maternal deaths]. / Enquête Nationale Confidentielle sur les Morts Maternelles en France, un système de surveillance améliorée depuis 25 ans, indispensable pour la caractérisation fiable des décès maternels.

Although maternal mortality is rare in wealthy countries, it remains a fundamental indicator of maternal health. It is considered to be a "sentinel event", the occurrence of which indicates dysfunctions, often cumulative, in the healthcare system. In addition to the classic epidemiological surveillance findings - number of deaths, maternal mortality ratio, distribution of medical causes, sub-groups of women at risk - its study, through a precise analysis of the history of each woman who died, enables to highlight areas for improvement in the content or organisation of care, the correction of which will make it possible to prevent not only deaths but also upstream morbid events involving the same mechanisms. To achieve this dual epidemiological and clinical audit objective, an ad hoc "enhanced" system is needed. France has had such a system since 1996, the Enquête Nationale Confidentielle sur la Mortalité Maternelle (ENCMM), under the joint supervision of Santé Publique France and Inserm. The ENCMM method aims to identify maternal deaths exhaustively and reliably up to 1 year after the end of pregnancy, and to document each death as fully as possible. The 1st step is the multi-source identification (direct declaration, death certificates, linkage with birth certificates, hospital stay database) of women who died during pregnancy or in the year following its end. The 2nd step is the collection of detailed information for each death by a pair of clinical assessors. The 3rd step is the review of these anonymised documents by the National Expert Committee on Maternal Mortality, which establishes the maternal nature of the death (causal link with pregnancy) and, with a stated aim of improvement rather than judgement, assesses the adequacy of care and the preventability of the death. The summary of the information gathered for maternal deaths in the 2016-2018 period is presented in the other articles of this special issue.

Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit.

INTRODUCTION: Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES: The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS: In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS: A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS: This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.

To Analyze and Evaluate the Rate of Compliance of Hand Hygiene Practices in a Tertiary Care Hospital: Initiation of Quality Improvement Program and Clinical Audit.

INTRODUCTION: Health care as a service organization is associated with hospital-acquired infection which is drawing attention. There are concerns raised by patients, attenders, stake holders, insurers, government agencies, and regulatory bodies. The study aims to evaluate the awareness and the rate of compliance with hand hygiene. METHODS: The audit methodology implemented is a concurrent medical record audit. The period of the audit was conducted for 6 months. A random sampling method was incorporated. The sample size was determined as 20% of the staff had been involved. RESULTS: The Total average level of awareness of hand hygiene and adherence to policy is 93.6%. The average of all the 3 categories of compliance at 5 levels of hand hygiene in percentage is 82.3%. DISCUSSION: Hand hygiene practices if stringently implemented will minimize the cross-transmission of infection in health care facilities. By knowing the awareness level and compliance level are measured with standardized training modules. APPLICATIONS: Create awareness on hand hygiene and provide training with respect to the effectiveness of implementation. Incorporate hand hygiene steps as well as in the audit process. CONCLUSIONS: There is a requirement for training with respect to the effectiveness of the implementation of the techniques. The level of care and quality of services can be made better by incorporating quality improvement programs (QIPs). By regular audits, we can raise the service quality and benchmark it.

What care do people with dementia receive at the end of life? Lessons from a retrospective clinical audit of deaths in hospital and other settings.

BACKGROUND: The need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings. METHODS: A retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models. RESULTS: The characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase. CONCLUSION: This study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases.

Effects of a team Quality Improvement method in a national clinical audit programme of four clinical specialties in Ministry of Health hospitals in Saudi Arabia.

In 2018, the Ministry of Health (MoH) in Saudi Arabia developed a clinical excellence strategy. An objective was to reduce variation in clinical practices in MoH hospitals, particularly for conditions with high mortality in Saudi Arabia, by applying best practice clinical standards and using the clinical audit process to measure clinical practice. The strategy included working with multiprofessional teams in hospitals to implement improvements needed in clinical practice. To test the feasibility of carrying out national clinical audits in MoH hospitals, audits were carried out in 16 MoH hospitals on four clinical subjects-acute myocardial infarction, major trauma, sepsis, and stroke. Clinical expert groups, including Saudi clinicians and an international clinical expert, developed clinical care standards for the four conditions from analyses of international and Saudi clinical guidelines. The audits were designed with the expert groups. Multiprofessional teams were appointed to carry out the audits in designated MoH hospitals. Data collectors in each hospital were trained to collect data. Workshops were held with the teams on the clinical care standards and how data would be collected for the audits, and later, on the findings of data collection and how to use the improvement process to implement changes to improve compliance with the standards. After 4 months, data collection was repeated to determine if compliance with the clinical care standards had improved. Data collected from each hospital for both cycles of data collection were independently reliably tested. All designated hospitals participated in the audits, collecting and submitting data for two rounds of data collection and implementing improvement plans after the first round of data collection. All hospitals made substantial improvements in clinical practices. Of a total of 84 measures used to assess compliance with a total of 52 clinical care standards for the four clinical conditions, improvements were made by hospital teams in 58 (69.1%) measures. Improvements were statistically significant for 34 (40.5%) measures. The project demonstrated that well-designed and executed audits using evidence-based clinical care standards can result in substantial improvements in clinical practices in MoH hospitals in Saudi Arabia. Keys to success were the improvement methodology built into the audit process and the requirement for hospitals to appoint multiprofessional teams to carry out the audits. The approach adds to evidence on the effectiveness of clinical audits in achieving improvements in clinical quality and can be replicated in national audit programmes.

Automated audit of hospital oxygen use devised during the COVID-19 pandemic.

BACKGROUND: The British Thoracic Society (BTS) has organised intermittent audits of hospital oxygen use in UK hospitals since 2008. Manual audits are time-consuming and subject to human errors. Oxygen prescribing and bedside observations including National Early Warning Scores (NEWS2 scores) are undertaken within an integrated electronic medical record (EMR) at this hospital. METHODS: The hospital's Business Information team were commissioned in late 2019 to devise a bespoke automated audit of oxygen prescribing and use. A summary report displays the oxygen saturation alongside the oxygen prescription status of every patient in the hospital except for critical care units which do not use NEWS2. The display has a 'traffic-light' colour scheme (green within target range, amber or red if below range or if above range on supplemental oxygen), with a graph showing oxygen use and saturation levels for patients with each prescribed target range. Clinicians can access raw data including oxygen saturation, oxygen device and flow rate for each individual patient. RESULTS: Over 51 audits involving 34 352 sets of observations, an average of 6.0% involved use of oxygen and 88.6% of these had a valid oxygen prescription. During the first wave of the COVID-19 pandemic in spring 2020, the monthly percentage of observations involving oxygen use increased to a peak of 10.4% followed by a rise to 10.6% during the second wave and 7.4% during the third (Omicron) wave. Oxygen use returned to baseline after each wave. CONCLUSIONS: In hospitals with integrated EMRs, it is possible to automate all fundamental aspects of the BTS oxygen audits and to monitor oxygen use at individual patient level and a hospital-wide level. This could be particularly valuable during major events such as the COVID-19 pandemic. This methodology could be extended to other clinical audits where the audit questions relate to routinely collected EMR data.

Liraglutide 3.0 mg and mental health: can psychiatric symptoms be associated to adherence to therapy? Insights from a clinical audit.

INTRODUCTION: Liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) analogue, is a medication approved for obesity treatment. This study aimed to investigate the relationship between psychiatric symptoms, including depression, anxiety, and binge eating, and their impact on therapy adherence. METHODS: A clinical audit was carried out on a cohort of 54 adults with obesity treated with liraglutide 3.0 mg. We retrospectively analyzed the connection between psychiatric symptoms assessed through the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and Binge Eating Scale (BES). Adherence to therapy was assessed by the maximum dosage (MD) and treatment duration (TD). RESULTS: Notably, a discontinuation rate of 59% was encountered. However, among those who continued the treatment, we observed a negative association between anxiety symptoms (STAI score) and MD, depression symptoms (BDI score) and TD, and a higher likelihood of binge eating (BES score > 17) and TD. Moreover, presence of psychiatric symptoms did not compromise drug's effectiveness in achieving weight loss, which was 4.43% (± 5.5 SD) in the whole sample and 5.3% (± 6.3 SD) in the subgroup evaluated at 12 weeks. CONCLUSION: We observed a high discontinuation rate in real-life clinical setting, where Liraglutide 3.0 therapy is paid out-of-pocket. While psychiatric symptoms might play a role in diminishing adherence to therapy, they do not prevent drug's effectiveness to promote weight loss. This finding underscores the potential advantages of liraglutide 3.0 mg therapy for individuals contending with obesity while simultaneously managing mental health challenges. LEVEL OF EVIDENCE: Level V, descriptive studies.

To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients.

BACKGROUND: The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. OBJECTIVE: We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. METHODS: We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. RESULTS: We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR]  = 2.9; 95% CI = 1.9-4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0-7.2, p = 0.042). CONCLUSION: The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.