Search Results (2,227)

Background/Objectives: Diagnosing acute pulmonary embolism (PE) is challenging due to its wide range of symptoms and numerous differential diagnoses. Medical professionals must balance performing all essential examinations and avoiding unnecessary testing. This study aimed to retrospectively audit the diagnosis and treatment of acute PE at a Swiss public teaching hospital to determine the adherence to current guidelines and to identify the factors associated with the delayed initiation of anticoagulation in PE patients. Methods: In this retrospective observational cohort study, we included all adult patients hospitalized with PE at the Cantonal Hospital Baselland (KSBL) between November 2018 and October 2020, where the diagnosis was made within the first twelve hours of their arrival to the emergency department (ED). LASSO regression was employed to identify clinical characteristics associated with delayed anticoagulation initiation. Results: A total of 197 patients were included (mean age: 70 years, 54% female). The audit revealed that diagnostic workup was conducted according to guidelines in 57% of cases. Often, D-dimer levels were measured although not strictly necessary (70%). Pretest probability was assessed and documented using the Wells or Geneva score in only 3% of patients, and risk assessment via the Pulmonary Embolism Severity Index (PESI) score was documented in 21% of patients. The median time from ED arrival to CT scan was 120 min (IQR 89.5–210.5), and the median time to anticoagulation initiation was 193 min (IQR 145–277). Factors identified by LASSO associated with delayed anticoagulation included prolonged time from ED arrival to CT scan, the presence of distended jugular veins on examination, ED arrival in the morning, and presenting symptoms of weakness or tiredness. Complementary leg ultrasound was performed in 57% of patients, with 38% of these cases lacking prior clinical examination for deep vein thrombosis. The duration of the anticoagulation treatment was not specified in the discharge report for 17% of patients. A medical follow-up after discharge was recommended in 75% of the patients. Conclusions: In conclusion, while the management of PE at the KSBL generally adheres to high standards, there are areas for improvement, particularly in the morning performance, the use of a pretest probability assessment, D-dimer measurement, risk assessment via the PESI score, the performance of complementary leg ultrasounds, clarification of the anticoagulation duration, and follow-up management. Full article

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background. Full article

This study explores the challenges and solutions faced by manufacturing companies in one industry when integrating green suppliers into their supply chains. The FGD transcripts were analyzed using NVivo 12 Pro for coding and thematic analysis, which helped identify key challenges and solutions. The key challenges identified included higher procurement costs, limited availability of green materials, quality assurance issues, and difficulties in verifying green practices. Strategic solutions involve establishing partnership strategies, conducting supply chain audits, and developing clear evaluation criteria. The content analysis shows that higher procurement costs can be mitigated through strategic partnerships offering better terms and pricing stability. Diversifying the supplier base and investing in supplier development programs address the limited availability of green materials. Quality assurance is maintained through stringent controls and regular audits, while verification challenges are managed with third-party certifications and robust audits to prevent greenwashing. The SWOT analysis highlights strengths such as strategic partnerships and regular audits, opportunities like developing evaluation criteria and technological advancements, and acknowledges weaknesses and threats. This comprehensive analysis provides a nuanced understanding of the practical challenges and solutions in green supply chain management, offering a strategic framework for manufacturing companies to enhance sustainability and achieve competitive advantage. Full article

Effective fiscal control and monitoring of public management are critical for preventing and mitigating corruption, which in turn, enhances government performance and benefits citizens. Given the vast amounts of data involved in government operations, applying advanced data analysis methods is essential for strengthening fiscal oversight. This paper explores data management strategies aimed at enhancing fiscal control, beginning with a bibliometric study to underscore the relevance of this research. The study reviews existing data capture techniques that facilitate fiscal oversight, addresses the challenges of data storage in terms of its nature and the potential for contributing to this goal, and discusses data processing methods that yield actionable insights for analysis and decision-making. Additionally, the paper deals with data interoperability, emphasizing the importance of these practices in ensuring accurate and reliable analysis, especially given the diversity and volume of data within government operations. Data visualization is highlighted as a crucial component, enabling the detection of anomalies and promoting informed decision-making through clear and effective visual representations. The research concludes with a case study on the modernization of fiscal control in Colombia, focusing on the identification of user requirements for various data-related processes. This study provides valuable insights for modern audit and fiscal control entities, emphasizing that data capture, storage, processing, interoperability, and visualization are integral to the effective supervision of public expenditure. By ensuring that public funds are managed with transparency, accountability, and efficiency, the research advances the literature by addressing both the technological aspects of data management and the essential process improvements and human factors required for successful implementation. Full article

The purpose of this study is to determine the impact of an internal auditor’s activities in Romania, through their specific activities, on ESG reporting and sustainable development goals (SDGs). Environmental, social, and governance (ESG) are three criteria by which an organization’s operations are characterized as sustainable, responsible, or ethical. Even though, for business, the SDGs have been called “a 2030 purchase order for business and government action today”, the alignment between environmental, social, and governance performance and sustainable development goals helps practitioners in observing corporate contributions to sustainable growth. This research aims to identify whether internal auditors in Romania are able to contribute to ESG reporting and the achievement of the sustainable development goals through specific objective assurance and advisory activities. Using the questionnaire, the data were collected from professional accountants who carry out internal audit missions. The main findings confirm a strong and directly significant connection between the internal audit’s perception of the management’s view of the SDGs and how the entity can contribute to achieving the SDG objectives. The results also showed a direct and medium-intensity impact of the variables, capturing the important role of internal audits in ESG reporting. Our study showed that internal audits can help with reporting ESG and sustainable development objectives through their activity. However, according to our statistical results, the internal auditors do not offer at all (or rarely offer) objective assurance and counseling related to these subjects. Moreover, it is observed that, in these situations, the management does not have a clear vision and has not taken measures to achieve the sustainable development goals and ESG factors. Full article

Implementing management systems in organisations of all types and sizes often raises the following question: “What benefits will this bring?” Initial resistance and criticism are common as potential challenges are identified during the implementation process. To address this, it is essential to highlight the advantages of these systems and engage stakeholders in supporting management efforts. While the planning, implementation, use, maintenance, auditing, and improvement of management systems are generally voluntary, certification is frequently driven by external factors, particularly customer demands. Employees also stand to gain significantly, with knowledge and information serving as valuable resources, especially for leveraging artificial intelligence. This article explores the management’s readiness to adopt and fully utilise two management systems based on international standards: the ISO 30401 Knowledge management system (KMS) and the ISO/IEC 42001 Artificial intelligence management system (AIMS). Through interviews, we assess the challenges and solutions associated with implementing these systems, whether planned or partially adopted. The findings illustrate the synergistic benefits of integrating the KMS and AIMS, demonstrating how their combined use can enhance Integrated Management Systems (IMSs). Such integration supports comprehensive planning, operation, and performance evaluation of processes and services while also promoting continuous improvement. Full article

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45–101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable. Full article

In the era of digitalization, the large availability of data and innovations in machine learning algorithms provide new potential to improve the prediction of energy efficiency in buildings. The building sector research in the Kingdom of Saudi Arabia (KSA) lacks actual/measured data-based studies as the existing studies are predominantly modeling-based. The results of simulation-based studies can deviate from the actual energy performance of buildings due to several factors. A clearer understanding of building energy performance can be better established through actual data-based analysis. This study aims to predict the energy efficiency of residential buildings in the KSA using supervised machine learning algorithms. It analyzes residential energy trends through data collected from an energy audit of 200 homes. It predicts energy efficiency using five supervised machine learning algorithms: ridge regression, least absolute shrinkage and selection operator (LASSO) regression, a least angle regression (LARS) model, a Lasso-LARS model, and an elastic net regression (ENR) model. It also explores the most significant explanatory energy efficiency variables. The results reveal that the ENR model outperforms other models in predicting energy consumption. This study offers a new and prolific avenue for the research community and other building sector stakeholders, especially regulators and policymakers. Full article

Background: Health disparities related to socio-economic factors impact access to preventive health interventions. The PRECEDE–PROCEED model, a multidimensional approach to health promotion, has been adapted to optimise cancer screening programs in Lombardy, Italy, addressing these disparities. Methods: This study evaluated the application of systemic audits based on the PRECEDE–PROCEED model across Lombardy cancer screening programs. A systematic region-wide audit was performed in 2019, and follow-up audits were performed in 2022–2023. Data were collected using structured analysis methodologies, including epidemiological, behavioural, and organisational assessments. Results: The 2019 audit showed strengths in participation and quality standards but identified challenges in cervical cancer screening coverage and waiting times for assessments. Improvements plans included the digitisation of processes and stakeholder engagement. The 2022–2023 audits reported increased coverage for breast and colorectal screenings, but a slight decline in participation rates and examination coverage. Organisational improvements were noted, yet gaps in training and equity-targeted actions remained. Conclusion: The PRECEDE–PROCEED model audits led to notable improvements in the quality and equity of cancer screening programs in Lombardy. Sustained focus on digital integration, continuous re-training, and targeted equity interventions is essential for further progress. Full article

Property Assessed Clean Energy (PACE) programs finance energy efficiency and renewable energy improvements to residential and commercial properties with a special tax assessment added to property taxes. This paper surveys the literature and documents the quantitative estimates of the environmental and economic benefits. This paper extends to discuss the securitization of PACE loans. The issuance of PACE green bonds frees up capacity for more PACE improvements. In addition, we summarize the concerns raised after the programs have been implemented. Those concerns include consumer protection, audit after program implementation, and lien-related risks for lenders. We discuss those concerns and suggest measures to continue to grow PACE financing. The success of PACE programs will contribute to reducing carbon emissions, mitigating climate change and to achieving six of the seventeen United Nations Sustainable Development Goals (SDGs). Full article

Objective: Our study aimed to evaluate the effectiveness of an intervention based on Motivational Interviewing (MI) performed by healthcare professionals in Primary Care (PC) patients with risky alcohol use through a multicenter, two-arm parallel, cluster-randomized, open-label controlled clinical trial. Methods: PC professionals were randomized into two groups: an Experimental Group (EG) and a Control Group (CG). The study was carried out in PC centers of the Andalusian Health Service, located in Cordoba, Spain. An MI-based approach was implemented with patients recruited in the EG, while health advice was provided to those included in the CG. The follow-up period was 12 months, with five visits scheduled. The consumption of standard drinking units per week was quantified, and risky alcohol use was estimated using the Alcohol Use Disorders Identification Test (AUDIT). An intention-to-treat statistical analysis was performed. Relative risk (RR), absolute risk reduction (ARR) and the number of subjects needed to treat (NNT) were used to estimate the intervention effect size. Results: A total of 268 patients were included, 148 in the EG and 120 in the CG. Considering the quantification of risky alcohol use, the ARR at 12 months after baseline visit was 16.46% (95% CI: 5.37–27.99), with an NNT of 6 (95% CI: 4–19). According to the AUDIT, the ARR at 12 months was 13.15% (95% CI: 2.73–24.24%), and the NNT was 8 (95% CI: 4–37). Conclusions: We concluded that MI is more effective than the usual health advice in decreasing risky alcohol use in patients treated in PC. Full article

Healthcare Information Exchange (HIE) is becoming a fundamental operation in current healthcare systems. In such systems, electronic health records (EHRs) are digitally stored inside each medical centers and, sometimes, are required to be shared between various healthcare facilities (HCFs). Indeed, sharing patient information is crucial and might be vulnerable to power outages, data misuse, privacy or security violations, and an audit trail. Hence, researchers have focused recently on cutting-edge technologies to develop secure HIE systems and ensure data privacy during transactions. Among such technologies, blockchain and artificial intelligence (AI) occupy a vital role in researchers’ focuses and efforts to detect risky transactions in HIE systems, thus enhancing their security and privacy. While the blockchain allows HCFs to link to each other without requiring a central authority, AI models offer an additional security layer when sharing patient data between HCFs. This paper presents a survey about HIE systems, and the aim is two-fold: we first present the architecture of HIE systems along with their challenges; then, we categorize and classify the current state-the-art-techniques that show the potential of using blockchain and AI technologies in such systems. Full article

The transition to digital business systems has revolutionized organizational operations, driven by the integration of advanced technologies such as artificial intelligence (AI). This integration indicates a shift, redefining traditional practices and enhancing efficiency across diverse sectors such as finance, healthcare, and manufacturing. This study explores the impact of AI on auditing through a systematic literature review to develop a conceptual framework for auditing practices. The theoretical implications show the transformative role of AI in redefining auditors’ roles, shifting from retrospective examination to proactive real-time monitoring. Moreover, managerial contributions stress the benefits of AI integration, enabling informed decision-making in risk analysis, financial management, and regulatory compliance. Future research should explore AI’s influence on auditing efficiency, performance, regulatory challenges, and auditor adaptation. Overall, this study underlines the importance for organizations to embrace AI integration in auditing practices, fostering innovation, competitiveness, and resilience. Full article

Risk management exerts a significant influence on the competitiveness of an organization and its operational processes. It presents opportunities for expansion, foresight, and the need to promote sustainability. Many organizations have executed comprehensive risk management processes. Moreover, internal audit has increasingly attracted managers’ attention, forming the basis of modern governance methods. The aim of this study is to examine, from the viewpoint of the agency, the impact of the role of internal auditors, training in risk management, and management support on risk management. Following this, the work examines risk management in terms of the risk-based auditing implementation that is performed by Saudi public organizations. This study encompassed 234 completed and therefore valid questionnaires from the manager and assistance of the internal audit department, internal auditors, accountants, and managers employed in Saudi public organizations. The data collected have been analyzed utilizing Smart Partial Least Squares (SmartPLS). This study’s findings confirmed that there is a significant association between the role of internal auditors in risk management, training in risk management, and between management support and risk management. There is also a significant association between risk management and the implementation of risk-based internal auditing. This study’s findings have significant ramifications for those in charge of public-sector organizations, and sustainability, aiming to enhance the dependability and trustworthiness of the internal audit process and other aspects of financial reports and audits in general. Currently, there is a dearth of published research on the factors that influence risk management and also on risk-based internal auditing. This study contributes to the emerging literature on this subject by examining Saudi public organizations; it also establishes empirical variables through a thorough review of relevant research. Conducted here is an empirical investigation that identifies the factors that affect risk management and then its influence on risk-based internal auditing implementation in the economic system of Saudi Arabia. By focusing on Saudi public organizations, this article highlights other countries that have similar systems of governance rules and procedures in their government-operated entities. Full article

Trichinellosis is a major foodborne zoonotic disease responsible for 41 human cases, according to the European Union One Health Zoonoses Report. In southern Spain, a quality management system (QMS) was applied to satellite laboratories (SLs) that conduct meat inspections of Trichinella spp. ensuring excellence practices. This study aimed to determine how eventual deviations from standard procedures may influence risk levels using Canonical Discriminant Analysis (CDA). Data were collected during slaughterhouses and game handling establishments’ official audits in 18 SLs located in the provinces of Cordoba and Seville during a 6-year period. Technical requirement deviations regarding technique and trial information, such as performing tests or calculations incorrectly or not following technical procedures, significantly increased risk level differences. Imminent risk levels were detected if the above-mentioned deviations arose. Quality assurance compromising deviations were responsible for 1150 times risk level differences, suggesting finding such may be critical for risk determination. A lack of significant influence of records and documents compromising deviations (incomplete forms or missing-erroneous or illegible data) was found. These results strengthen Trichinella spp. control strategies by pinpointing crucial aspects within QMS that require improvement, particularly in addressing deviations related to technique, trial information, and quality assurance procedures to mitigate associated risks effectively. Full article