What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

OBJECTIVES: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). DESIGN: Interrupted time series analysis, review of case notes, survey, and interviews. SETTING: Acute and primary care trusts in England and Wales. PARTICIPANTS: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. MAIN OUTCOME MEASURES: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. RESULTS: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P <0.002) and orlistat for obesity (P <0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer’s disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. CONCLUSIONS: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context

Improvement of the Model of Using Analytical Procedures at Internal Auditing of a Bank

From 2014 the number of banks in Ukraine essentially decreased from 180 to 76 for 01.07.2019. The unstable situation was traced in the country for this period of time. Liquidation of 104 banks demonstrated that they couldn't manage their risks and make correct managerial decisions timely, and also the system of internal control functioned badly. Just this system includes a subdivision of internal auditing that didn't cope with timely revelation of inexactitudes, so reasonable recommendations as to managerial decisions weren't elaborated. For providing functions of internal auditing of a bank, the subdivision uses auditing procedures. They include analytical procedures that, in their turn, are principal for attaining aims of an auditing task. The article considers most urgent questions of using analytical procedures in internal bank auditing. The essence of the definition of “analytical procedures” has been considered and specified. Analytical procedures have been separated from the composition of auditing ones, and their theoretical aspect has been analyzed. The classification of methods of analytical procedures has been analyzed for getting auditing evidences. Analytical procedures consist of methods of internal system estimation and bank financial condition analysis and also analysis of their business-processes. Advantages and defects of methodical components of analytical procedures have been presented and analyzed. The stages of an auditing task have been studied. Analytical procedures are considered at three stages of internal auditing: planning, performing the engagement and resulting, demonstrated through the prism of economic analysis. International standards of the professional practice of internal auditing that regulate it are considered. Questions of working papers that generalize a result of using analytical procedures are separated

Cooperation on Competition: The Multistate Tax Commission and State Corporate Tax Uniformity

This report explores how interstate uniformity of state corporate income taxes has varied over time, the role played by the MTC, and how likely it is that uniformity will be achieved. FRC Report 11

CONSIDERATIONS ON AUDIT OF GROUP FINANCIAL STATEMENTS

The objective of this paper is to present a comparative analysis of the consolidatedfinancial statements according to the International Financial Reporting Standards or the EuropeanDirectives and see how such accounting alternative affect the explanatory notes to the consolidatedfinancial statements, especially regarding to the revaluation basis of the assets. The study seeks todetermine if the accounting diversity influences the work of the financial auditor. The resultsindicate that the two frameworks in elaborating the consolidated financial statements have asignificant ascendancy on the audit of the group financial statements.Consolidated Financial Statements, The 7th European Directive, Financial Audit

Iowa Lottery Authority, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2006

State Audit Report