Optic disc haemorrhage audit

Poster section INTRODUCTION. Retrospective Analysis PURPOSE. To evaluate the morphology and location of optic disc haemorrhages (ODH) identified at diabetic retinopathy (DR) screening to establish whether particular ODH are predictive of ocular disease (e.g. glaucoma). METHODS. Retrospective analysis of 77 patients who presented with ODH at DR screening in the Birmingham and Black Country screening programme between June 2009-March 2010. Mean age was 71 years (range 39-89). Cup/disc ratio (CDR), location and morphology of the haemorrhage were recorded. The outcome of the referral and the status of the ODH were followed up a year later. RESULTS. Of the 77 referred, 34 patients were unassessed for possible glaucoma. Of the 43 patients that were assessed in the hospital eye service for glaucoma, 11 (26%) were diagnosed with glaucoma. These glaucoma patients mostly presented with flame haemorrhages (64%) and blot haemorrhages (36%). Haemorrhages tended to adjoin the margin of the OD (64%), and were more commonly flame shaped (64%). They less commonly occurred in the optic disc itself (36%), and were all blot shaped. The OD Cup/disc ratio (CDR) of the patients with glaucoma (n=11) ranged from 0.33-0.57. It is interesting to note the highest CDR was 0.68 in the 77 patients referred. 32 patients were confirmed as not having glaucoma. 24 (75%) of these patients presented with an ODH adjoining the margin, of which 20 (83%) were flame, and 4 blot (17%) shaped. Only 8 (25%) presented with an ODH in the OD, of which 6 (75%) were blot shaped. One year follow up of the 77 referred cases revealed that the ODH resolved in 45 (57%) patients while 10 (13%) still had an ODH present. 15 (21%) were still under ophthalmology hence digital retinal photos were not available for assessment. Six patients (8%) (age range 71-91 years) died within the year, and one lost to follow up. CONCLUSIONS. The results suggest that a significant number of patients with ODH have glaucoma and that the differing morphology of the haemorrhage is not a major predictor i.e. blot versus flame shaped, adjoining or in the optic disc. The cup/disc ratio did not predict glaucoma either.

Follow the money:the Audit Commission, Public Money and the Management of Public Services, 1983-2008, Duncan Campbell-Smith

Book review: Duncan Campbell-Smith. Allen Lane, 2008, 744 pp., £ 25 (hb), ISBN: 9781846140686

The global audit profession and the international financial architecture:understanding regulatory relationships at a time of financial crisis

This paper explores how regulatory relationships in the global audit arena are being affected by the current financial crisis. Key policy initiatives and debates are analyzed, along with institutional interactions, in particular between the International Federation of Accountants (IFAC), international regulators and the large audit firms. The events are placed in the context of the new international financial architecture which has developed over the last decade. Using the illustrative lens of bank auditing, questions are asked of the nature and status of audit practice and the regulatory arrangements governing such practice. The paper shows the active nature of the regulatory responses to the crisis and the shifting and competing influences among key regulatory and professional participants in the global audit arena. Emphasis is placed on the need for audit researchers to be sensitive to the developing global financial architecture, and its potential implications for the study of audit practice in different national and international contexts.

Report for CeDo:CeDo - receptivity for change audit

Briefing report (Time 1 of 2) for CeDo, a private sector manufacturer

Ambulatory electroencephalogram in children:a prospective clinical audit of 100 cases

Ambulatory electroencephalogram has been used for differentiating epileptic from nonepileptic events, recording seizure frequency and classification of seizure type. We studied 100 consecutive children prospectively aged 11 days to 16 years that were referred for an ambulatory electroencephalogram to a regional children's hospital. Ambulatory electroencephalogram was clinically useful in contributing to a clinical diagnosis in 71% of children who were referred with a range of clinical questions. A diagnosis of epileptic disorder was confirmed by obtaining an ictal record in 26% and this included 11 children that had previously normal awake and or sleep electroencephalogram. We recommend making a telephone check of the current target event frequency and prioritising those with typical events on most days in order to improve the frequency of recording a typical attack.

Customer loyalty among daily disposable contact lens wearers

Background: Optometric practices offer contact lenses as cash sale items or as part of monthly payment plans. With the contact lens market becoming increasingly competitive, patients are opting to purchase lenses from supermarkets and Internet suppliers. Monthly payment plans are often implemented to improve loyalty. This study aimed to compare behavioural loyalty between monthly payment plan members and non-members. Methods: BBR Optometry Ltd offers a monthly payment plan (Eyelife™) to their contact lens wearers. A retrospective audit of 38 Eyelife™ members (mean. ±. SD: 42.7. ±. 15.0 years) and 30 non-members (mean. ±. SD: 40.8. ±. 16.7 years) was conducted. Revenue and profits generated, service uptake and product sales between the two groups were compared over a fixed period of 18 months. Results: Eyelife™ members generated significantly higher professional fee revenue ( P<. 0.001), £153.96 compared to £83.50, and profits ( P<. 0.001). Eyelife™ members had a higher uptake of eye examinations ( P<. 0.001). The 2 groups demonstrated no significant difference in spectacle sales by volume ( P= 0.790) or value ( P= 0.369). There were also no significant differences in contact lens revenue ( P= 0.337), although Eyelife™ members did receive a discount. The Eyelife™ group incurred higher contact lens costs ( P= 0.037), due to a greater volume of contact lens purchases, 986 units compared to 582. Conclusions: Monthly payment plans improve loyalty among contact lens wearers, particularly service uptake and volume of lens purchases. Additionally the greater professional fees generated, render monthly payment plans an attractive business model and practice builder.

Regulating audit beyond the crisis:a critical discussion of the EU green paper

With the European Commission making global leadership claims in the field of audit regulation, the content of its 2010 Green Paper on ‘Audit Policy: Lessons from the Crisis’ warrants careful scrutiny. Important issues raised in the Green Paper include regulatory oversight, competition in the audit market, the dangers of having very few firms with the capacity to audit global transnational corporations, professional judgement, innovative audit practices and, last but not least, social responsibility. This article analyses the principal perspectives and assumptions underpinning the construction of the Green Paper. The aims are threefold: to enhance understanding of the contemporary regulatory mindset of the European Commission, contribute to policy debate and inspire future research.

Does audit improve quality in a hospital manufacturing unit?

OBJECTIVE - To establish whether auditing improves the overall quality of a hospital manufacturing unit. DESIGN - Continuous assessment of the quality level of a hospital manufacturing unit using 14 quality indicators over a nine-month period, and two periods of audit carried out towards the beginning and end of the assessment period. SETTING - The non-sterile manufacturing, sterile manufacturing and repackaging services areas at the pharmacy manufacturing unit at Queens Hospital, Burton-on- Trent. RESULTS - Compliance ratings for the second audit were better than those for the first audit, but there was no overall improvement in quality over the study period. CONCLUSION - Auditing probably improves compliance by focusing the minds of the staff involved, rather than by initiating a sustained improvement in overall quality.

Abolishing the Audit Commission:framing, discourse coalitions and administrative reform

The abolition of the Audit Commission in England raises questions about how a major reform was achieved with so little controversy, why the agency lacked the institutional stickiness commonly described in the literature on organisational reform and why it did not strategise to survive. In this paper, we apply argumentative discourse analysis to rich empirical data to reveal the pattern and evolution of storylines and discourse coalitions, and the ways in which these interact with and affect the practices of Parliament, the media and the Audit Commission itself. Our analysis shows that the politics of administrative reform are as much about discursive framing and the ability of pro-reformers to gain discursive structuration and institutionalisation as they are about the material resources available to a newly elected government and its ministers. Questions of technical feasibility are unlikely to derail a reform initiative once its promoters gain discursive ascendency.

Optic Disc Haemorrhage (ODH) audit:should morphology determine referral?

A retrospective analysis of 77 patients who presented with ODH at DR screening in the Birmingham And Black Country Screening Programme between June 2009 -March 2010. Of 77 detected, 34 were referred with possible glaucoma and this was confirmed in 11 cases (26%) of those referred. The complete results suggest that ODH is a high indicayor for glaucoma but that differing morphology of ODH is not a major predictor.