Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

IntroductionThe COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methodsDatasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. ResultsForty-four centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase.ConclusionsOur audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

Dialogical approach to a highly controlled discourse

This paper sets out the results of an analysis of a corpus of interviews with certified accountants who work or have worked for a major international audit group (one of the Big 4). It uses a dialogical and enunciative approach to show how highly controlled discourses are employed to criticize the “affective temporality” in these large firms. The interviewees all mention the difficulty of living with certain emotions within these Big 4 firms (in particular with the following “temporal emotions”: boredom with repetitive tasks, cold relationships, stress and pressure). We use the pedagogical context of data collection and the professional context of the interviewees to interpret these controlled discourses, while strongly mobilizing the responsive dimension of dialogism.

Audit of banks as public interest entities: Segmentation and conjuncture of the bank audit market in Ukraine

An important factor in restoring the confidence of financial consumers in banks is to provide auditors with credible and detailed financial statements and their solvency. This study is a pilot step in clarifying the auditor’s role in ensuring the banks’ reliability as public interest entities in Ukraine. It is aimed at investigating the segmentation of the banking audit services market in Ukraine and its comprehensive characteristics. Structural and dynamic analysis were applied to investigate market, regional and branch concentration, as well as main trends in bank audit market development within the data and registers of the Audit Chamber of Ukraine (ACU) and 75 annual reports of Ukrainian banks. Key aspects of the bank audit market in Ukraine are highlighted: the potential of the bank audit market, the ability of auditors to provide audit services and current characteristics of market conjuncture. Bank audit market is highly segmented: this study differentiates strong segments of international audit networks, associations and alliances, including Big 4 companies and the segment of weak Ukrainian audit companies. Kyiv and Kyiv region are the dominant economic active regions in terms of the regional bank market concentration and the presence of international audit networks. The study results are the basis for improving the regulation of the banking audit services market by the National Bank of Ukraine and ACU.

Timing of orchidopexy and its relationship to postoperative testicular atrophy: results from the ORCHESTRA study

Background In 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering the age at orchidopexy to under 1 year. There are concerns that a younger age at operation may increase postoperative testicular atrophy. The ORCHESTRA study aimed to establish the current age at orchidopexy in a multicentre, international audit and to see whether testicular atrophy was affected by age at operation. Methods The study was undertaken over a 3-month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was done using a standardized, predetermined protocol. The primary outcome was postoperative testicular atrophy. Secondary outcomes were wound infections, reoperations, and unplanned hospital stays related to anaesthetic events. Results A total of 417 patients were included, of whom only 48 (11.5 per cent) underwent orchidopexy before 1 year of age. There was no difference in anaesthetic complications in boys aged less than 1 year versus older patients: 0 of 48 (0 per cent) versus 6 of 369 (1.6 per cent) (P = 0.999). Complete follow-up was available for 331 patients (79.4 per cent). There was no difference in atrophy rate between those aged less than 1 year and older boys: 1 of 37 (3 per cent) versus 9 of 294 (3.1 per cent) (P = 0.999). Reoperation rates were 0 of 37 (0 per cent) and 7 of 294 (2.4 per cent) respectively (P = 1.000). There were more wound infections in boys under 1 year of age: 4 of 37 (11 per cent) versus 7 of 294 (2.4 per cent) (P = 0.025). Conclusion Only 11.5 per cent of boys underwent surgery before the age of 1 year. There was no increased risk of postoperative testicular atrophy with early surgery, although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy undertaken in boys aged over 1 year.

INCREASE IN AUDIT RISKS OF NON-DETECTION OF SCAM IN A PANDEMIC

The impact of Covid-19 on the quality of audits has been studied and the risks of increasing the range for fraud have been identified. The article outlines the range of services provided by audit companies, including: accounting, financial reporting, tax services, payroll services, labor support and insurance, planning and reporting, consulting services. These factors indicate that the number of frauds increased during Covid-19 and may increase, as fraud detection is more difficult in the digital environment. Revenues for 2020 and 2021 are outlined and a rating of the 10 largest international audit companies is built. An analytical assessment of changes in the income of each of the represented international audit companies was performed. It is noted that companies registered in the United States have adapted to the economic landscape changed by Covid-19. It was noted that according to the Audit Analytics report, 800 companies reported changes in their internal control related to changes in pandemic risks. The dynamics of the total income of audit firms of the Big Four from 2009 to 2020 is given. It is stated that while Deloitte received the largest share of its revenue in America, KPMG's Amsterdam-based revenue was the largest in Europe, the Middle East and Africa. It is noted that the two leading international audit companies received a significant portion of their revenues from auditing, assurance, auditing and corporate risks. The income of international audit firms of the Big Four by types of activity in 2020 on the international market of services is allocated. Management fraud statistics are estimated at 12%, auditor and accountant statistics at 14% worldwide, and operating fraud statistics at 15%. In general, the ability of management to compare the financial statements prepared by the accountant with external auditors helps in assessing performance and risk assessment, and the independent auditor's opinion serves as a guide for relevant stakeholders in decision-making, and creates and helps reduce information asymmetry. The dynamics of changes in the number of employees for the period 2020 -2021 in the 10 most successful international audit companies in the world. The impact of remote work through the COVID-19 pandemic and the feedback from audit firms and their employees through organizational support (employer-to-employee) and organizational commitment (employee-to-employer commitment) are identified. The division of organizational support into: a sense of support for the company and a sense of support for colleagues. In general, in the event of a pandemic, the vast majority of meetings take place through digital communication channels, which significantly affects the well-being and mental state of staff.

The perceptions of loan officers and auditors of factors affecting auditor independence: Evidence from Palestine

The study investigates the perceptions of external auditors and loan officers regarding external auditor's independence in Palestine. Data were gathered using a questionnaire developed by the author and include 5 main issues related to the perception of external auditor’s independence. The sampling population identified for this study consists of external auditors working in domestic and international audit firms and financial statement users mainly loan officers in Palestine. The sample included 79 auditors and 76 loan officers. The findings revealed that there are significant differences in the perceptions of external auditors and loan officers in relation to provision of non-audit services, auditor’s economic dependence on a single audit client, and long relationship between an auditor and a client. The results revealed mixed results about the effect of presence of active audit committee on independence of the external auditors. Furthermore, acceptance of significant gifts from the client was considered an important factor that may influence auditor independence by loan officers and external auditor and thus significant differences between the two respondent groups were found in relation to acceptance of significant gifts from the client. These findings can be useful to policy makers and professional auditing bodies in Palestine on setting new regulations or strengthening existing ones to enforce auditor’s independence in Palestine.