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.

Self-Assessment Tool and Clinical Audits: A Way to Manage Organ Donation and Transplantation in Hospital Settings.

The self-assessment tool (SAT) of hospital management in donation and transplantation is a systematic instrument that allows reaching a situation status on Procurement and Transplantation with emphasis on the management and cultural change of Health Personnel in each care center. The SAT allows reflection on institutionalization, achievements, and the cultural change generated by donation and transplantation in Health Personnel. It also allows the evaluation of the culture of hospital donation and the formulation of plans and goals for the future. The SAT evaluates 5 components (Logistics, Education, Communication, Donation Culture, and Results Evaluation) with 30 questions and reflects the core aspects of the hospital donation process. The answers to the SAT are numbered and based on the total score. We can classify the management and its results as insufficient, basic, intermediate, and advanced. The SAT was applied in 8 hospitals whose donation results are externally audited, and their results were compared with the result of the self-assessment. The SAT was useful in supporting and guiding the work of the intra-hospital transplant coordinator; it allows the classification of the hospital, taking into account the main aspects of donation and transplant management and, based on this, generating a package of measures for improvement.

Growth management and prevalence of underweight of indigenous children (Orang Asli) in Peninsular Malaysia: a clinical audit.

BACKGROUND: Most indigenous people (Orang Asli in Peninsular Malaysia) live in poverty, and their children are at risk of growth problems due to nutrition deficiency. Routine health and growth assessments are essential to identify these children. This clinical audit aimed to determine the growth management of indigenous children and the prevalence of underweight among these children in Perak state, Malaysia. METHODS: A clinical audit was conducted in 2016 after obtaining consensus from stakeholders for audit criteria, forms, and procedures. All weight-for-age growth charts of Orang Asli children aged 2 and below were sampled for retrospective audit. This audit excluded children who required special needs. Growth charts were examined against audit criteria: (i) quality of growth chart plotting (charts were not plotted, incompletely plotted, or incorrectly plotted), (ii) presence of underweight, and (iii) appropriateness of action taken (appropriate or inappropriate action) according to local standard operating policies. Eligible auditors were first trained using simulated growth charts. RESULTS: Out of 1329 growth charts audited, 797 (60%) growth charts were correctly plotted, 527 (39.7%) were incompletely or incorrectly plotted, and five (0.3%) were not plotted. Overall, 40.0% of the growth chart was plotted incorrectly or completely not plotted. 550 (41.4%) children were found to be underweight, and 71.5% of them received inappropriate care management. Where growth charts were correctly plotted, 283 children were identified with underweight problems, and 194 (68.6%) of them received inappropriate care. For growth charts that were plotted incompletely or incorrectly, 267 children were identified as having underweight problems, and 199 (74.5%) received inappropriate care. The growth status of 265 (19.9%) children was unable to be determined due to incomplete plotting. CONCLUSION: Approximately 40% of indigenous Orang Asli children aged 2 years and under were underweight, and most of them received inappropriate care.

Quality/risk management system in radiotherapy: Changes afoot.

The French sanitary and regulatory context in which radiotherapy centres are comprised is evolving. Risk and quality management systems are currently adapting to these evolutions. The French nuclear safety agency (ASN) decision of July 1st 2008 on quality assurance obligations in radiotherapy has reached 10 years of age, and the French high authority of health (HAS) certification system 20 years now. Mandatory tools needed for the improvement of quality and safety in healthcare are now well known. From now on, the focus of healthcare policies is oriented towards evaluation of efficiency of these new organisations designed following ASN and HAS nationwide guidelines.

AUDCRED: ferramenta de apoio para auditoria de contas em saúde / AUDCRED: support tool for auditing health accounts

Introdução: Uma das ferramentas de qualidade mais eficientes para monitorar um sistema de gestão é a auditoria, pois, quando bem aplicada, diagnostica não conformidades no serviço avaliado, sendo executada por profissionais capacitados que apresentam, além do conhecimento técnico-científico, atributos pessoais como imparcialidade, prudência e diplomacia. Objetivos: O objetivo geral do estudo foi desenvolver uma ferramenta móvel que possa servir de apoio para o processo de auditoria de contas médicas e os objetivos específicos foram: identificar os requisitos necessários para o desenvolvimento da ferramenta de auditoria; apresentar um protótipo e desenvolver uma ferramenta garantindo os requisitos de segurança necessários à manutenção da informação pessoal, possibilitando sua implementação, distribuição e modificação e avaliar o impacto da ferramenta para a auditoria em saúde no âmbito da Marinha do Brasil. Método: Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa, aplicado à produção tecnológica e destinado a desenvolver uma ferramenta informatizada móvel para apoio ao serviço de auditoria de contas médicas. Para desenvolvimento da ferramenta foi utilizada a metodologia de Pressman, seguindo as seguintes etapas: coleta e refinamento dos requisitos, elaboração de projeto rápido, construção do protótipo, avaliação pelo cliente e posterior refinamento quando há necessidade de ajustes finais do projeto, com o intuito de satisfazer da melhor forma as necessidades dos clientes. Resultados: Foram distribuídos 75 formulários para os auditores da Marinha e, tendo sido respondidos 65 (84,3%), observou-se que 40,9% dos entrevistados eram enfermeiros e 29% não tinham experiência em auditoria. As falas dos entrevistados foram analisadas, emergindo cinco categorias relacionadas a melhorias e uma a crítica, sendo estas respectivamente: ampliar o módulo para controle e previsão de custos; regular os serviços que serão prestados pela contratada; orientar profissionais a executarem a auditoria em saúde; ampliar módulo para que possam ser apresentados indicadores e relatório; disponibilizar mais informações sobre os credenciados e não entender o propósito da ferramenta. Conclusão: Acredita-se que a ferramenta irá contribuir para que os auditores recém-ingressos na Marinha possam executar o processo de auditoria de acordo com a técnica, gerando uniformidade, dando celeridade e, principalmente, evitando perdas para a organização. Dessa forma, favorecendo ao profissional mais habilidade e destreza em todo processo

Introduction: One of the most efficient quality tools to monitor a management system is the audit, because, when properly applied, it diagnoses non-conformities in the service evaluated, being performed by trained professionals who have, in addition to technical-scientific knowledge, personal attributes such as impartiality, prudence and diplomacy. The general objective of the study was to develop a mobile tool that can support the medical bills audit process and the specific. Objectives: The general objective of the study was to develop a mobile tool that can support the medical bill audit process and the specific objectives were: to identify the necessary requirements for the development of the audit tool; present a prototype and develop a tool ensuring the security requirements necessary for the maintenance of personal information, enabling its implementation, distribution and modification, and evaluating the impact of the tool for health auditing within the Brazilian Navy.Method: This is a descriptive, exploratory study with a qualitative approach applied to technological production, aimed at developing a mobile computerized tool to support the medical bill audit service. For development of the tool, Pressman's methodology was used, following the steps: collection and refinement of requirements, rapid design development, prototype construction, customer evaluation and further refinement when there is a need for final design adjustments, in order to satisfy the best way to meet the needs of customers. Results: 75 forms were distributed to the Navy auditors, with 65 (84.3%) answered, it was observed that 40.9% of respondents were nurses, 29.% had no experience in auditing. The speeches of the interviewees were analyzed emerging five categories related to improvements and one the criticism, respectively: expanding the module for cost control and forecasting; regulate the services that will be provided by the contractor; guide professionals to perform the health audit; expand module so that indicators and report can be presented; provide more information about the accredited and do not understand the purpose of the tool. Conclusion: It is believed that the tool will help auditors who have recently joined the Navy to perform the audit process according to the technique, generating uniformity, speeding up and, above all, avoiding losses for the organization. In this way, providing the professional with more skill and dexterity throughout the process

Outliers from national audits: their analysis and use by the Care Quality Commission in quality assurance and regulation of healthcare services in England.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. As part of the intelligence-driven approach to regulation, the CQC works closely with national clinical audit bodies to identify key metrics which reflect quality of care and track the performance of providers against these metrics. Where outliers on national audits are identified that may reflect risks to patients, the CQC encourages the hospital to identify any learning points and implement changes to improve patient care.In this article, we describe the role of national audit outcomes in the regulatory process and how providers can use national audits to inform both quality assurance and quality improvement processes, with two illustrative case studies. We discuss the ongoing challenges with using audit data in the regulatory process and how these could be addressed.

Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System.

OBJECTIVES: In Germany, cesarean section (CS) rates more than doubled within the past two decades. For analysis, auditing and inter-hospital comparison, the 10-Group Classification System (TGCS) is recommended. We used the TGCS to analyze CS rates in two German hospitals of different levels of care. METHODS: From October 2017 to September 2018, data were prospectively collected. Unit A is a level three university hospital, unit B a level one district hospital. The German birth registry was used for comparison with national data. We performed two-sample Z tests and bootstrapping to compare aggregated (unit A + B) with national data and unit A with unit B. RESULTS: In both datasets (national data and aggregated data unit A + B), Robson group (RG) 5 was the largest contributor to the overall CS rate. Compared to national data, group sizes in RG 1 and 3 were significantly smaller in the units under investigation, RG 8 and 10 significantly larger. Total CS rates between the two units differed (40.7 vs. 28.4%, p<0.001). The CS rate in RG 5 and RG 10 was different (p<0.01 for both). The most relative frequent RG in both units consisted of group 5, followed by group 10 and 2a. CONCLUSIONS: The analysis allowed us to explain different CS rates with differences in the study population and with differences in the clinical practice. These results serve as a starting point for audits, inter-hospital comparisons and for interventions aiming to reduce CS rates.

Assessment of the practice of pediatrics procedural sedation and analgesia for magnetic resonance imaging and computed tomography scan at a teaching hospital, Ethiopia, 2020: A clinical audit.

BACKGROUND: The main goals of paediatric sedation/general anesthesia vary according to the specific imaging procedure, but generally includes anxiety relief, pain control and control of excessive movement. The quality of magnetic resonance imaging (MRI) and computed tomography (CT) depends largely on immobility of the patient during the procedure, which is often difficult to achieve without sedation in children. Sedation is the depression of the central nervous system and reflexes by the administration of drugs. Brain imaging is routinely used to identify stroke, hemorrhage, and structural abnormalities. All patients undergoing procedural sedation and those receiving general anesthesia should be evaluated equally. AIM: The study aimed to perform a clinical audit of sedation and analgesia practices for magnetic resonance imaging and computed tomography compared against the guidelines/standards to determine if practice meets the standards and identify areas of non-compliance at a teaching Referral Hospital in Ethiopia. METHODS: This clinical audit was conducted from January 1 to May 30/2020 for 5 months at a teaching Referral Hospital in Ethiopia. All children below the age of 6 years underwent MRI and CT imaging procedures under sedation during a study period were included. Data were collected through direct observation using checklists of standards by a trained data collector. Descriptive statistics were presented with tables, graphs of sums and percentages of items using SPSS version 20. RESULTS: A total of 40 children underwent MRI and CT imaging were observed at the Hospital imaging sites. Among the 20 standards, 6 of them had 100% compliance rate, 3 of the standards had 0% complaince rate and 11 of the standards had the compliance rate of between 0 and 100%. CONCLUSIONS AND RECOMMENDATIONS: In general, even though the practice guidelines of procedural sedation for MRI and CT recommend to practice procedures based on the standards, this study showed there were a number of standards that had <100% compliance rate. Therefore, it is recommended that staff should adopt standards or locally prepared protocols for their day-to-day practice.

An audit of UK audiological practice in specialist paediatric oncology centres regarding hearing assessment of children at risk of ototoxicity due to chemotherapy.

OBJECTIVE: Platinum-based chemotherapy drugs are associated with substantial ototoxicity. The hearing of children treated with these drugs should be closely monitored. METHOD: A questionnaire was sent out to the 19 audiology departments associated with national paediatric cancer specialist centres in the UK looking at current practice in ototoxicity monitoring. RESULTS: Responses were received from 17 of 19 centres (89 per cent). All offered some form of audiometric monitoring service. Extended high-frequency testing (9-20 kHz) was only utilised by 7 services (29 per cent). A majority of respondents were reluctant to consider self-test devices in paediatric ototoxicity monitoring (n = 9; 53 per cent). Provision of long-term audiological follow up is sporadic with only 4 (23 per cent) respondents keeping all children with normal hearing under review once treatment is completed. CONCLUSION: While some good practice in paediatric ototoxicity was identified, opportunities exist to improve clinical practice and protocols, promote multidisciplinary team working and to utilise technologies such as extended high frequency and self-test audiometry.

Epidemiology of trauma presentations to a major trauma centre in the North West of England during the COVID-19 level 4 lockdown.

PURPOSE: The COVID-19 pandemic has impacted healthcare systems globally, little is known about the trauma patterns during a national lockdown. The aim of this study is to delineate the trauma patterns and outcomes at Aintree University Teaching Hospital level 1 Major Trauma Centre (MTC) during the COVID-19 lockdown imposed by the U.K. government. METHODS: A retrospective cohort study data from the Merseyside and Cheshire Trauma Audit and Research Network database were analysed. The 7-week 'lockdown period' was compared to a 7-week period prior to the lockdown and also to an equivalent 7-week period corresponding to the previous year. RESULTS: A total of 488 patients were included in the study. Overall, there was 37.6% and 30.0% reduction in the number of traumatic injuries during lockdown. Road traffic collisions (RTC) reduced by 42.6% and 46.6%. RTC involving a car significantly reduced during lockdown, conversely, bike-related RTC significantly increased. No significant changes were noted in deliberate self-harm, trauma severity and crude mortality during lockdown. There was 1 mortality from COVID-19 infection in the lockdown cohort. CONCLUSION: Trauma continues during lockdown, our MTC has continued to provide a full service during lockdown. However, trauma patterns have changed and departments should adapt to balance these alongside the COVID-19 pandemic. As the U.K. starts its cautious transition out of lockdown, trauma services are required to be flexible during changes in national social restrictions and changing trauma patterns. COVID-19 and lockdown state were found to have no significant impact on survival outcomes for trauma.

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England.

AIMS: People with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D. METHODS: Data were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2). RESULTS: Two hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9-10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods). CONCLUSION: Sensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

Ensuring universal assessment and management of vitamin D status in melanoma patients at secondary care level: a service improvement project.

BACKGROUND/AIMS: Melanoma is the most aggressive skin malignancy with an ever-increasing caseload, especially in the western world. Recently developed immunotherapeutic modalities have substantially improved the prognosis of advanced melanoma. The association between serum levels of vitamin D and prognosis of melanoma has been a focus of ongoing research, with some evidence of vitamin D's potential as an adjunctive modality to immunotherapy. The National Institute for Health and Care Excellence guidelines clearly recommend that assessment of vitamin D levels and relevant advice should be an inherent aspect of the management of patients with melanoma at the secondary care level. METHOD: A service improvement project was conducted to ensure full compliance of practice in the authors' skin unit with the current National Institute for Health and Care Excellence guidelines on the management of vitamin D status in patients with melanoma. RESULTS: After two reaudits the unit's practice complied with National Institute for Health and Care Excellence guidelines by using a multidisciplinary team approach. CONCLUSIONS: The authors propose that the simple and reliable pathway used to achieve and sustain the results could be easily adopted to ensure universal adherence to these guidelines.

Could a multidisciplinary regional audit identify avoidable factors and delays that contribute to stillbirths? A retrospective cohort study.

BACKGROUND: The annual rate of stillbirth in Sweden has remained largely unchanged for the past 30 years. In Sweden, there is no national audit system for stillbirths. The aim of the study was to determine if a regional multidisciplinary audit could help in identifying avoidable factors and delays associated with stillbirths. METHODS: Population-based retrospective cohort study. SETTINGS: Six labour wards in Stockholm County. PARTICIPANTS: Women delivering a stillbirth > 22 weeks of gestation in Stockholm during 2017. INTERVENTION: A multidisciplinary team was convened. Each team member independently assessed the medical chart of each case of stillbirth regarding causes and preventability, level of delay, the standard of healthcare provided, the investigation of maternal/foetal diseases and if any recommendations were given for the next pregnancy. A decision was based on the agreement of all five members. If no agreement was reached, a reassessment of the case was done and the medical record was scrutinized again until a mutual decision was made. Primary outcomes: The frequency of probably/possibly preventable factors associated with a stillbirth and the level of delay (patient/caregiver). SECONDARY OUTCOMES: The causes of death, the standard of antenatal/intrapartum/postpartum care, whether a summary of possible causes of the stillbirth was made and if any plans for future pregnancies were noted. RESULTS: Thirty percent of the stillbirths were assessed as probably/possibly preventable. More frequent ultrasound/clinical check-ups, earlier induction of labour and earlier interventions in line with current guidelines were identified as possibly preventable factors. A possibly preventable stillbirth was more common among non-Swedish-speaking women (p = 0.03). In 15% of the cases, a delay by the healthcare system was identified. Having multiple caregivers, absence of continuity in terms of attending the antenatal clinic and not following the basic monitoring program for antenatal care were also identified as risk factors for a delay. CONCLUSION: A national/regional multidisciplinary audit group retrospectively identified factors associated with stillbirth. Access to good translation services or a more innovative approach to the problem regarding communication with mothers could be an important factor to decrease possible patient delays contributing to stillbirths. TRIAL REGISTRATION: NCT04281368 .

A importância dos registros de enfermagem no contexto avaliativo da auditoria / The importance of nursing records within the audit assessment context

Objetivo: Analisar a importância dos registros de enfermagem no contexto avaliativo da auditoria. Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados LILACS, MEDLINE e BDENF, por meio dos descritores Auditoria de Enfermagem; Auditoria Clínica; Registros de Enfermagem; Anotações de Enfermagem e Enfermagem. A busca foi realizada de 12 de janeiro a 26 de fevereiro de 2018 e selecionados 17 artigos que compõem o estudo. Resultados: a importância dos registros de enfermagem no contexto avaliativo da auditoria se dá pela investigação da qualidade do cuidado prestado por meio das evidências proporcionadas nos registro/anotações de enfermagem no portuário do paciente, evitar prejuízos na continuação do cuidado, intensificar sugestões de implantações de valores educacionais por meio da educação continuada e permanente, resgatar os valores econômicos perdidos por glosas em contas hospitalares e promover a melhoria da qualidade da assistência. Conclusão: foi possível verificar que, mesmo sendo uma prática que deva ser realizada com qualidade, o processo de auditora ainda encontra muita fragilidade nas informações encontradas nos diversos registros do profissional de enfermagem, o que acarreta grandes prejuízos.

Objective: To analyze the importance of nursing records in the evaluative context of the audit. Method: This is an integrative literature review performed in the LILACS, MEDLINE and BDENF databases using the descriptors Nursing Audit; Clinical audit; Nursing records; Nursing and Nursing Notes. The search was performed from January 12 to February 26, 2018, selecting a total of 17 articles. Results: the importance of nursing records in the evaluative context of the audit is due to the investigation of the quality of care provided through the evidence provided in the nursing records/annotations in the patient's chart, avoiding losses in the continuation of care, intensifying suggestions for implantation of nursing care, educational values through continuing and continuing education, recovering the economic values lost by disallowances in hospital bills and promoting the improvement of the quality of care. Conclusion: it was possible to verify that, even though it is a practice that should be performed with quality, the audit process still finds a lot of fragility in the information found in the various records of the nursing professional, which causes great losses.

Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homes.

BACKGROUND/OBJECTIVES: In April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28-point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes. DESIGN: Longitudinal cohort study. SETTING: A total of 360 Massachusetts NHs. PARTICIPANTS: The Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123 "special focus" facilities with infection control deficiencies for on-site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed of resources for the acquisition of personal protective equipment (PPE), backup staff, and SARS-CoV-2 testing. MEASUREMENTS: We used two data sources: (1) four state audits of all NHs, and (2) weekly NH reports to the Massachusetts Center for Health Information and Analysis. Primary independent process measures were the checklist scores and adherence to each of its six core competencies. Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff. We used a hurdle mixed effects model adjusted for county COVID-19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths. RESULTS: Both resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups. Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates. CONCLUSION: This statewide effort could serve as a national model for other states to prevent the devastating effects of pandemics such as COVID-19 in frail NH residents.

Task shifting of emergency caesarean section in south Ethiopia: are we repeating the brain drain.

INTRODUCTION: preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women´s lives every year, almost all in low- and middle-income countries. However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered. METHODS: a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced. RESULTS: from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI: 18.3-69.4; p=0.003). CONCLUSION: our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.

An audit of licenced Zambian diagnostic imaging equipment and personnel.

INTRODUCTION: Estimates indicate that two-thirds of the world's population lack adequate access to basic medical imaging services integral to universal health coverage (UHC). Furthermore, sparse country-level radiological resource statistics exist and there is scant appreciation of how such data reflect healthcare access. The World Health Organisation posits that one X-ray and ultrasound unit for every 50,000 people will meet 90% of global imaging demands. This study aimed to conduct a comprehensive review of licensed Zambian radiological equipment and human resources. METHODS: An audit of licensed imaging resources, using the national updated Radiation Protection Authority and Health Professions Council of Zambia databases. Resources were quantified as units or personnel per million people, stratified by imaging modality, profession, province and healthcare sector, then compared with published Southern African data. RESULTS: Over half of all equipment (153/283 units, 54%) and almost two thirds of all radiation workers (556/913, 61%) are in two of ten provinces, serving one third of the population (5.49/16.4, 33.5%). Three-quarters of the national equipment inventory (212/283 units, 75%) and nearly ninety percent of registered radiation workers (800/913, 88%) are in the public sector, serving 96% of the population. Southern African country-level public-sector imaging resources principally reflect national per capita healthcare spending. CONCLUSION: To achieve equitable imaging access pivotal for UHC, Zambia will need a more homogeneous distribution of specialised radiological resources tailored to remedy disparities between healthcare sectors and provincial regions. Analyses of licenced radiology resources at country level can serve as a benchmark for medium-term radiological planning.

Prechemotherapy nursing assessment among adult cancer patients in a university cancer center in Shanghai, China: a best practice implementation project.

OBJECTIVE: The current implementation project aimed to promote evidence-based practice with prechemotherapy nursing assessment among adult cancer patients in a large university cancer center in Shanghai, China, over a 6-month timeframe. INTRODUCTION: Prechemotherapy nursing assessment is an essential element of cancer patient care, aiming to prevent or minimize potential problems from chemotherapy treatment. Regular comprehensive prechemotherapy assessment is not part of routine care currently in many clinical settings within China. METHODS: The project utilized the JBI approach to implementation, incorporating audit and feedback tools. Twelve evidence-based audit criteria were developed for use in the program. A baseline audit was conducted of prechemotherapy nursing assessment among adult cancer patients, with a sample size of 68 patients and 36 nursing staff. Following implementation of systematic strategies based on the analysis of three main barriers, a follow-up audit involving a similar sample as the first audit was conducted using the same audit criteria. RESULTS: The baseline audit indicated that for nursing assessment among adult cancer patients undergoing chemotherapy, the criteria (1, 10, 11 and 12) which related to nurse education, weight measurement, premedication and access device assessment had very high compliance (from 93 to 100%). Compliance for criteria (2, 6, 7, 9) related to medical history, previous exposure to chemotherapy, patients' or caregivers' comprehension of treatment and psychosocial assessment was 0%, while compliance with the other five criteria (3, 4, 5, 8) was low, ranging from 16 to 61%. There was improvement in all 12 criteria in the follow-up audit. Criteria 1, 11 and 12 maintained high compliance (100%). Criterion 2 (patients' medical history), criterion 3 (presence or absence of allergies), criterion 7 (previous exposure to chemotherapy) and criterion 9 (psychosocial elements) demonstrated a significant improvement in compliance. Although progress has been made, there were still some criteria that require further improvement. These included assessment of patients' current diagnosis and cancer status (criterion 4, from 61 to 66%), recent laboratory results (criterion 5, from 31 to 62%), patients' and/or caregivers' comprehension of information regarding the disease and treatment (criterion 6, from 0 to 34%), any previous exposure to chemotherapy agents (criterion 7, from 0 to 57%), and physical assessment of the patient (criterion 8, from 46 to 72%). CONCLUSION: The project achieved increased compliance with evidence-based best practice in all assessed audit criteria improving the practice of prechemotherapy assessment. Involvement of informatics technology is a great strategy to help overcome barriers, simplify the change process and assist in sustaining evidence-based practice change. Future plans and ideas are in place and have been discussed. Further audits will need to be carried out to improve the validity and quality of nursing assessment.