Surgical audit: are we not closing the loop?

2018 ◽  
Vol 31 (8) ◽  
pp. 966-972 ◽  
Author(s):  
Declan Dunne ◽  
Nikhil Lal ◽  
Nagarajan Pranesh ◽  
Michael Spry ◽  
Christopher Mcfaul ◽  
...  
Keyword(s):  
No Value ◽  
General Surgery ◽  
Clinical Medicine ◽  
Multi Centre Study ◽  
Content Type ◽  
Closing The Loop ◽  
Audit Cycle ◽  
Surgical Audit ◽  
Audit Activity ◽  
Clinical Audits

PurposeA clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.Design/methodology/approachThis was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.FindingsOf the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.Originality/valueThis study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

Observation of Nursing Care of Patients with Acute Severe Pulmonary Embolism after General Surgery under Microscope

2021 ◽  
Vol 7 (5) ◽  
pp. 1459-1468
Author(s):  
Wenbin Liang ◽  
Jing Shen ◽  
Yuanling Zhang ◽  
Hongbing Li ◽  
Bangxing Yu
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
General Surgery ◽  
Acute Pulmonary Embolism ◽  
Clinical Medicine ◽  
Positive Impact ◽  
Survey Methods ◽  
Clinical Manifestations ◽  
Effective Rate ◽  
Treatment Rate

Acute pulmonary embolism (APE) is one of the common acute and critical illnesses in clinical medicine, and it is another high cause of death after heart disease, cancer and cardiovascular disease. Despite the unremitting research and exploration of many relevant experts in recent years, major progress has been made in diagnosis and treatment, but the clinical manifestations of acute pulmonary embolism are not specific, and there is a lack of effective and definite methods for diagnosis. The mortality rate of patients with acute pulmonary embolism remains high. Furthermore, the combination of multiple postoperative diseases caused by general surgery can also increase the mortality of patients. Based on this, this article uses microscope technology to study and analyze the pretreatment methods and nursing methods of patients with acute severe pulmonary embolism after general surgery to improve the condition of patients with acute pulmonary embolism and increase their recovery rate, hoping to be the domestic acute pulmonary embolism The treatment provides reference and reference. This article first summarizes the relevant theories of surgery and acute pulmonary embolism, and then uses experimental methods, data analysis methods, survey methods and comparison methods, and SPSS 22.0 statistical analysis software technology to observe the efficacy of patients after thrombolytic therapy through a microscope. It is concluded that in the sample data of 50 cases, the significant rate accounts for 58%, the effective rate accounts for 36%, and the inefficiency accounts for 6%, confirming the positive impact of early thrombolytic therapy on patients with acute pulmonary embolism. Finally, through the microscope observation and comparison of the patient’s physical signs before and after nursing, it is concluded that timely and effective nursing after surgery has a great effect on improving the treatment rate of patients.

Closing the loop between evidence-based medicine and care delivery: a possible role for clinical audits in spinal surgery

2013 ◽  
Vol 13 (12) ◽  
pp. 1951-1957 ◽  
Author(s):  
Justin M. Dazley ◽  
Thomas D. Cha ◽  
Mitchel B. Harris ◽  
Christopher M. Bono
Keyword(s):  
Evidence Based Medicine ◽  
Spinal Surgery ◽  
Care Delivery ◽  
Evidence Based ◽  
Closing The Loop ◽  
Based Medicine ◽  
Clinical Audits

Knowledge has no value until it is shared: an empowering leadership perceptive

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Misbah Hayat Bhatti ◽  
Umair Akram ◽  
Muhammad Hasnat Bhatti ◽  
Tabassum Riaz ◽  
Nausheen Syed
Keyword(s):  
Knowledge Sharing ◽  
No Value ◽  
Social Exchange ◽  
Organizational Level ◽  
Empowering Leadership ◽  
Content Type ◽  
Affective Trust ◽  
Individual Level ◽  
High Level ◽  
The Relationship

Purpose The effect of empowering leadership on knowledge sharing is well defined, but factors that stimulate employees for knowledge sharing are still limited. Therefore, this study aims to address to what extent empowering leadership is desirable to create a trustful and fair environment that is conducive for an employee’s knowledge sharing. Design/methodology/approach Through integration of social exchange, equity and uncertainty management theories develop a moderating mediating model that links empowering leadership to knowledge sharing. Three-wave data collection from the sample of 375 managers–subordinates’ dyads was done in Pakistan textile industries. Findings Hierarchal regression analysis and bootstrapping method were applied to test the hypotheses. The results indicate that affective trust partially mediates the relationship between empowering leadership and knowledge sharing. More especially, the findings demonstrate that the relationship between empowering leadership and knowledge sharing becomes strong with high level of distributive and procedural justices. Practical implications This research study uses empowering leadership as a proposed motivational pathway for stimulating employee’s knowledge sharing through development of affective trust and buffering effect of distributive and procedural justices. Originality/value Most of previous research in knowledge sharing just cynosure organizational-level elements like leadership and organizational justices but deteriorate individual factors like trust. Therefore, this study will combine both organizational- and individual-level factors for urging employees for knowledge sharing.

An empirical investigation of repeat buying behavior of customers of two brands in India

2014 ◽  
Vol 6 (3) ◽  
pp. 255-268 ◽  
Author(s):  
Mehir Baidya ◽  
Gautam Ghosh
Keyword(s):  
No Value ◽  
Empirical Investigation ◽  
Primary Data ◽  
Buying Behavior ◽  
Content Type ◽  
Fund Allocation ◽  
Total Process ◽  
Data Points ◽  
Repeat Purchase ◽  
Practical Implications

Purpose – The purpose of this paper is to attempt to test whether price and quality have any influence on customer repeat purchase probability. Managers should know the strategic determinants of repeat purchase probability to retain customers. Design/methodology/approach – Primary data were gathered on repeat purchase, price and quality via a survey of 400 customers of two brands in the Business-to-customer (B2C) sector. Then 380 × 4 data points to a logit model were fitted to estimate the effects of price and quality on customer repeat purchase probability. Findings – It was found that price, quality and price × quality influence customer repeat purchase probability substantially. Furthermore, the elasticities of repeat purchase probability to price and quality are quite high in both cases. Practical implications – Managers should use elasticities to determine how to allocate funds between price and quality to maximize repeat purchase probability. Originality/value – In view of the complexity of customer repeat buying behavior, this study deals with one aspect or feature of the total process, which does not mean that it has no value. By confirming two strategic determinants of customer repeat purchase probability and suggesting a simple rule of fund allocation, this work definitely adds some research of value to the relevant marketing literature.

A clinical decisions unit improves emergency general surgery care delivery

2015 ◽  
Vol 20 (4) ◽  
pp. 191-198 ◽  
Author(s):  
Chris Johnstone ◽  
Rachel Harwood ◽  
Andrew Gilliam ◽  
Andrew Mitchell
Keyword(s):  
Decision Making ◽  
Hospital Stay ◽  
General Surgery ◽  
Care Delivery ◽  
Fixed Bed ◽  
Surgical Care ◽  
Early Discharge ◽  
Clinical Decisions ◽  
Readmission Rates ◽  
Content Type

Purpose – Early access to senior decision makers and investigations has improved outcomes for many conditions. A surgical clinical decisions unit (CDU) was created to allow rapid assessment and investigation by on-call senior surgical team members to facilitate decision making and, if appropriate, discharge within a set time frame (less than four hours). The purpose of this paper is to compare outcomes for unscheduled general surgery admissions to the hospital before and after commissioning this unit. Design/methodology/approach – Prospectively collected hospital episode statistics data were compared for all general surgical admissions for one year prior to (July 2010-June 2011) and two years after (July 2011-June 2013) the introduction of the CDU. Statistical analysis using the Mann Whitney U-test was performed. Findings – More patients were discharged within 24 hours (12 per cent vs 20 per cent, p < 0.001) and total hospital stay decreased (4.6 days vs 3.2 days, p < 0.001) following introduction of CDU. Admission via A & E (273 vs 212, p < 0.01) was also decreased. Overall there was a 25.3 per cent reduction in emergency surgical admissions. No difference was noted in 30-day readmission rates (47 vs 49, p=0.29). Originality/value – The introduction of a CDU in has increased early discharge rates and facilitated safe early discharge, reducing overall hospital stay for unscheduled general surgical admissions. This has decreased fixed bed costs and improved patient flow by decreasing surgical care episodes routed through the emergency department (ED). In all, 30-day readmission rates have not been influenced by shorter hospital stay. Service redesign involving early senior decision making and patient investigation increases efficiency and patient satisfaction within unscheduled general surgical care. Not original but significant in that the model has not been widely implemented and this is a useful addition to the literature.

scholarly journals Injecting some audit into substance misuse services

1997 ◽  
Vol 21 (6) ◽  
pp. 360-363
Author(s):  
Beelin Baxter ◽  
Stephen Green ◽  
Olwen Williams ◽  
Woody Caan
Keyword(s):  
Practice Guidelines ◽  
Health Authority ◽  
Substance Misuse ◽  
Diverse Group ◽  
Regional Health ◽  
East Anglia ◽  
Audit Cycle ◽  
One Year ◽  
Audit Activity ◽  
Drug And Alcohol

The former East Anglia Regional Health Authority initiated a 3-year project beginning in 1993. This aimed to introduce audit skills and to promote sustained audit activity across a diverse group of statutory and independent sector drug and alcohol agencies. Prior to this there had been little interest in audit for this area of care and no good models of practice were available from elsewhere in the NHS which could readily be adapted to the needs of the Anglian services. Eventually 24 agencies collaborated in this project, which introduced a system of reciprocal peer audit between the agencies which was supported by a dedicated facilitator, a programme of auditor training, and an Agency Audit Representative Group to prioritise topics for audit and to agree common standards. Progress was very slow to begin with. By May 1995, 12 agencies had completed an initial audit of 2–4 topics each from a regional menu of 12 priorities. One year later, 12 more services have undertaken such an initial audit and nine out of the original dozen (75%) have completed their first ‘audit cycle’ with a re-audit of the same topics. There has been an increase in the number of agencies meeting all the standards in their chosen topics, and in the number of topics where all standards are met, wherever those topics have been audited. Two new practice guidelines have also been developed by the agency representatives.

How institutional theories explain and fail to explain organizations

2020 ◽  
Vol 33 (7) ◽  
pp. 1223-1252
Author(s):  
Herman Aksom ◽  
Inna Tymchenko
Keyword(s):  
Institutional Theory ◽  
No Value ◽  
Strategic Behavior ◽  
Radical Change ◽  
Institutional Pressures ◽  
Science Literature ◽  
Organizational Fields ◽  
Content Type ◽  
And Behavior ◽  
Methodology Of Science

PurposeThis essay raises a concern about the trajectory that new institutionalism has been following during the last decades, namely an emphasis on heterogeneity, change and agentic behavior instead of isomorphism and conformist behavior. This is a crucial issue from the perspective of the philosophy and methodology of science since a theory that admits both change and stability as a norm has less scientific weight then a theory that predicts a prevalence of passivity and isomorphism over change and strategic behavior. The former provides explanations and predictions while the latter does not.Design/methodology/approachThe paper offers an analysis of the nature, characteristics, functions and boundaries of institutional theories in the spirit of philosophy and methodology of science literature.FindingsThe power of the former institutional theory developed by Meyer, Rowan, DiMaggio and Powell lies in its generalization, explanation and prediction of observable and unobservable phenomena: as a typical organizational theory that puts forward directional predictions, it explains and predicts the tendency for organizations to become more similar to each other over time and express less strategic and interest-driven behavior, conforming to ever-increasing institutional pressures. A theory of isomorphism makes scientific predictions while its modern advancements do not. Drawing on Popper's idea of the limit of domains of explanation and limited domains of theories we present two propositions that may direct our attention towards the strength or weakness of institutional theories with regard to their explanations of organizational processes and behavior.Practical implicationsThe paper draws implications for further theory building in institutional analysis by suggesting the nature of institutional explanations and the place of institutional change in the theoretical apparatus. Once institutional theory explains the tendency of the system towards equilibrium, there is no need to explain the origins and causes of radical change per se. Institutional isomorphism theory explains and predicts how even after radical changes organizational fields will move towards isomorphism, that is, institutional equilibrium. The task is, therefore, not to explain agency and change but to show that it is natural and inevitable processes that organizational field will return to isomorphic dynamics and move towards homogenization no matter how much radical change occurred in this field.Originality/valueThe paper discusses the practical problems with instrumental utility of institutional theories. In order to be useful any theory must clearly delineate its boundaries and offer explanations and predictions and it is only the former 1977/1983 institutional theory that satisfies these requirements while modern advancements merely offer ambiguous theoretical umbrellas that escape empirical tests. For researchers therefore it is important to recognize which theory can be applied in a given limited domain of research and which one has little or no value.

Bibliometric analysis on OA articles of public health emergencies from multidimensional perspective

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Xin Feng ◽  
Liming Sun ◽  
Yuehao Liu ◽  
Jiapei Li ◽  
Ye Wu
Keyword(s):  
Public Health ◽  
Clinical Medicine ◽  
Short Review ◽  
Development Trend ◽  
Data Set ◽  
Content Type ◽  
Research Results ◽  
Public Health Emergencies ◽  
Advantages And Disadvantages ◽  
Institutional Cooperation

PurposeThis paper aims to explore the development trend of OA articles and their advantages and disadvantages in the process of fighting the pandemic, and conduct a multi-level and multi-angle analysis of the relationship between publishing costs and the influence of OA articles.Design/methodology/approachThis study first compares the total number of articles in Web of Science with the number of OA articles, and the total number of COVID-19 related articles with the total number of OA articles. Subsequently, using the methods of institutional cooperation co-occurrence network, keyword co-occurrence and multidimensional scale analysis, and using the literature on the topic of COVID-19 in CNKI (Chinese National Knowledge Infrastructure) as the data set, we generate visualized maps of research results distribution and keyword co-occurrence network with the help of the Statistical Analysis Toolkit for Infometrics (SATI)FindingsThe research results show that the citation frequency and use frequency of OA articles related to COVID-19 are significantly higher than that of non-OA articles. OA articles dominate in the anti-pandemic process, with a series of advantages such as short review cycle, timeliness, high social benefit, high participation and fast dissemination playing an important role. Under the model of author's non-payment for OA article, the degree of institutional cooperation and author cooperation is enhanced, which improves the fluidity of knowledge, strengthens close links between keywords and enhances significant academic influence; OA articles will continue to promote research in the field of COVID-19, but the lack of quality of some OA articles may hinder their development. Then OA articles will further focus on clinical medicine, and related results will continue to promote the development and communication of OA articles in this field.Originality/valueCorresponding measures are also proposed for the existing problems of OA articles, to provide a reference for the publication and dissemination of OA articles in public health emergencies in the future.

Relationship between altmetric and bibliometric indicators across academic social sites in article-level: the case of Iranian researchers' “Top Papers” in clinical medicine

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Zahra Batooli ◽  
Azam Mohamadloo ◽  
Somayyeh Nadi-Ravandi
Keyword(s):  
Social Media ◽  
Social Impact ◽  
Clinical Medicine ◽  
Citation Impact ◽  
Academic Research ◽  
Scientometric Analysis ◽  
Content Type ◽  
Five Dimensions ◽  
Positive Correlation ◽  
Number Of Citations

PurposeThe study aimed to measure scientific and social impacts of Iranian researchers' “Top Papers” in clinical medicine using citation and altmetric indicators.Design/methodology/approachIn this applied descriptive-analytical study, it used scientometric analysis. A total of 166 “Top Papers” of Iranian researchers in clinical medicine category of Web of Science (WoS) database including “Highly Cited Papers” and “Hot Papers” published between 2009 and 2019 were used. Overall, 29 indicators and their data were extracted from WoS, Scopus, ResearchGate (RG) and PlumX in March 2020.FindingsThe results showed that there exists a positive correlation between the number of citations in WoS, Scopus, RG, PubMed and Crossref. In addition, it was found that there existed a positive correlation between the received citations by articles and altmetric indicators. According to the results, there is a strong correlation between RG Research Interest and citation impact. The correlation analysis on the Plum Analytics categories including “Usage”, “Capture”, “Mention”, “Social Media” and “Citation” showed the correlations between five dimensions of impact were positive and significant. The results have led the authors to think more about new metrics that can response to new developments in the new information areas.Research limitations/implicationsThere are limitations to access altmetric.com in Iran and cannot be used easily. On the other hand, because of considering 24 indicators, authors had to investigate only a sample of 166 top papers from Iranian researchers to present the detailed results. About nature of altmetric indicators, although they reflect the nonacademic impact of articles alongside bibliographic indicators, they still cannot be a complete representative of the influence of their owners.Practical implicationsThis study can indicate a practical application appropriate for the future study. It would be valuable to further examine how social academic platforms construct images of impact of research and how this impacts the social impact of the university as a mission. This study suggests that social media attention to academic research can be much greater than what is shown in traditional indicators such as citation.Originality/valueThis study examines 29 indicators from four platforms including RG, WoS, Scopus and PlumX, simultaneously and measures the relationship among them.

Tightroping between APT and BCI in small enterprises

2017 ◽  
Vol 25 (3) ◽  
pp. 226-239
Author(s):  
Jesse Kaukola ◽  
Jukka Ruohonen ◽  
Antti Tuomisto ◽  
Sami Hyrynsalmi ◽  
Ville Leppänen
Keyword(s):  
No Value ◽  
Design Methodology ◽  
Small Enterprises ◽  
Security Attacks ◽  
Structured Interviews ◽  
Content Type ◽  
Advanced Persistent Threat ◽  
Regional Market ◽  
Information Assets ◽  
Subjective Security

Purpose The contemporary internet provisions increasingly sophisticated security attacks. Besides underlining the advanced nature of these attacks, the concept of an advanced persistent threat (APT) catalyzes the important perspective of longitudinal persistence; attacks are not only carefully planned and targeted but the subsequent exploitation period covers long periods of time. If an APT successfully realizes into such exploitation, information assets may be continuously monitored for harvesting business-critical information (BCI). These threats are relevant for the security of small enterprises, and this study aims to examine the qualitative factors that shape the security mindsets among these. Design/methodology/approach The data are collected with semi-structured interviews of six enterprises in a small regional market segment. The analysis is based on a fourfold taxonomy that delivers three mindset profiles, while particular emphasis is placed on the subjective security notions that shape the typical strategizing among enterprises. Findings APT is poorly understood among the observed segment, which tends to often also explicitly downplay the strategic relevance of the concept, but a more pressing challenge relates to the observation that business data is often perceived to have no value. The delivered results can be used to improve the situation. Originality/value This study is among the firsts to explore perceptions of small enterprises toward APT and BCI. The results reveal problematic mindsets and offers new avenues for practitioners as well as academics to study and improve the situation.

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