Prioritising the care of critically ill children: a pilot study using SCREEN reduces clinic waiting times

Objective In low-resource settings, childhood mortality secondary to delays in triage and treatment remains high. This paper seeks to evaluate the impact of the novel Sick Children Require Emergency Evaluation Now (SCREEN) tool on the waiting times of critically ill children who present for care to primary healthcare clinics in Cape Town, South Africa. Methods We used a pre/postevaluation study design to calculate the median waiting times of all children who presented to four randomly chosen clinics for 5 days before, and 5 days after, the implementation of SCREEN. Findings The SCREEN programme resulted in statistical and clinically significant reductions in waiting times for children with critical illness to see a professional nurse (2 hours 45 min to 1 hour 12 min; p<0.001). There was also a statistically significant reduction in the proportion of children who left without being seen by a professional nurse (25.8% to 18.48%; p<0.001). Conclusions SCREEN is a novel programme that uses readily available laypersons, trained to make a subjective assessment of children arriving at primary healthcare centres, and provides a low cost, simple methodology to prioritise children and reduce waiting times in low-resource healthcare clinics

The impact of narcissism, self-confidence and auditor’s characteristics on audit report readability

Purpose: The present study aims to assess the impact of narcissism, self-confidence and auditor's characteristics on audit report readability for companies listed on the Tehran Stock Exchange. Design/methodology/approach: The study’s statistical population comprises firms listed on the Tehran Stock Exchange. The present research used a systematic elimination method, and 1,162 firm-year observations were obtained for seven years from 2012 to 2018. Three variables including auditor tenure, audit fee and audit specialization are used for measuring auditing features. The Fog index is used as a proxy for measuring audit report readability. In addition, in this paper, four regressions, including fixed effects, random effects, pooled and T+1, are used to estimate reliable coefficients. Findings: The findings show a negative and significant relationship between auditor’s characteristics (tenure, fee and specialization) and audit report readability. Moreover, the variables of the auditor’s narcissism, self-confidence and mandatory auditor change have a positive and significant association with audit report readability. This study lends support to the theories of personality disorder and behavioral decision. Originality/value: Since narcissism and self-confidence are two characteristics that shape an individual’s character and personality, some involved behavioral factors in auditors’ characteristics contribute to their decisions. The effects of these should be detected to enhance the decision-making process. The said factors significantly impact audit report readability. Hence, this paper attempts to assess the effect of the said factors on audit report readability

Assessing the reliability and accuracy of nurse triage ratings when using the South African Triage Scale in the Emergency Department of District Headquarter Hospital of Timergara, Pakistan

ObjectiveTo assess inter and intra-rater reliability, as well as accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in the Emergency Department (ED) of District Headquarter (DHQ) Hospital of Timergara, Pakistan.MethodsThis is a cross-sectional study using 42 previously validated paper based vignettes. Fifteen ED nurses assigned triage ratings to each of the 42 vignettes under classroom conditions. Validation of the SATS was done using the vignettes as a reference standard. Graphical displays portrayed rating distribution and validation measures of sensitivity, specificity, overtriage and undertriage across different acuity levels.ResultsThe estimated Quadratically weighted Kappa (QWK) and Interclass Correlation was found to be substantial at 0.77(CI 0.69–0.85). Intra-rater reliability with exact agreement was shown to be 87% (CI 67–100) with one category discrepancy showing 100% agreement. An average sensitivity, 70%; specificity, 97%; overtriage, 14.7% and undertriage, 21.6% was shown. The Graphical displayed showed that Very Urgent, Urgent and routine acuity levels had acceptable levels of overtriage and undertriage.ConclusionThe SATS has been shown to be a reliable triage scale for a developing country such as Pakistan. With accuracy being acceptable in the context of Timergara, we would suggest further validation studies looking at simple ways of validating the triage scale bearing in mind the challenges facing a developing country ED

Does intellectual capital and corporate governance have an impact on annual report readability? Evidence from an emerging market

Purpose: This study examines the impact of intellectual capital efficiency and corporate governance mechanisms on the annual report readability of Oman's financial sector companies. Design/methodology/approach: The study uses a sample of 150 firm-year observations of listed financial sector companies in the Muscat Securities Market, Oman, from 2014 to 2018. Flesch Reading ease and Flesch Kinkaid Index are used as proxies for annual report readability. As part of sensitivity analysis, the study also uses the natural logarithm of annual report pages as alternative readability measures. The investigation is conducted using random effects regression analysis and supported with system GMM estimation for robustness. Findings: The findings of this study demonstrate a decrease in intellectual capital efficiency associated with better readability of annual reports for the financial sector firms. Alternatively, banks report a positive association of intellectual capital efficiency with the Flesch Reading ease score of the annual report. The structural capital and capital employed efficiency are also found to be negatively associated with annual report readability. Corporate governance mechanisms such as dispersed ownership and audit committee size also result in easy-to-read annual reports that support agency theory. Research limitations/implications: The research was conducted for financial firms of Oman, and thereby the findings can be generalized to the financial sector of countries with similar settings, such as the Gulf Cooperation Council (GCC) region. Practical implications: The policy implications arising from this study suggest a strengthening of the intellectual capital efficiency and corporate governance mechanisms to improve the readability of the firms and thereby increase investor confidence. Originality/value: This paper's uniqueness is in the model used to investigate the impact of intellectual capital efficiency and corporate governance mechanisms on the annual report readability of an emerging market

Reliability and accuracy of the South African triage scale when used by nurses in the emergency department of Timergara hospital Pakistan

Background: Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched. OBJECTIVE: To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan. METHODS: Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard. RESULTS: Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intrarater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%). CONCLUSION: ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed

Examining social media, citizen engagement and risk communication: a smart city perspective

Governments around the world have had a varied response to social media adoption to communicate and engage their citizens. For the official purpose, social media has been used to create awareness of policies, ongoing projects, and new and other important public announcements. The smart city concept is predominantly based on the technology implementation that is expected to create sustainable economic development and improved quality of life. Oman 2040 strategy has aimed to achieve Smart Cities as a national ambition. During the pandemic, social media became an invaluable tool for the direct transmission of important information directed toward saving lives. This chapter aims to investigate the communication strategies and level of citizen engagement during COVID-19, through the Ministry of Health (MoH) Twitter posts in Oman. It also examines the risk communication strategies by MoH. The social media posts are analysed for the pandemic’s initial six-month period in Oman which began on 24th February 2020. A total of 1722 COVID-19-related tweets were analysed. The content analysis of the tweets suggested the MOH preferred to use the push strategy of communication during the COVID-19 period. The tweets were predominantly communicating the risk related to the pandemic. This study is expected to benefit the governments, health agencies, community and researchers as it provides insights on citizen engagement and risk communication strategies

A systematic literature review of intellectual capital and sustainable development of health care

The healthcare sector is one of the major sectors affected by the novel coronavirus (COVID-19). The pandemic brought enormous pressure on the health care sector thus shifting focus on valuing its intellectual capital (IC) and ensuring sustainable development. IC is critical for not only achieving a competitive advantage but also influencing sustainable development. The existing literature remains fragmented and underexposed with relation to IC and sustainable development in the health care sector. To address this issue, this study undertakes a systematic literature review of the IC and sustainable literature specific to the healthcare sector (n = 39). After analysing research articles indexed in Scopus, the findings highlight that publications in this area have been the highest over the last four years and around 50 per cent in the field of business, management, environmental sciences and social science combined. The extant literature has predominantly explored areas falling under three major themes, strategic approach, systems, and performance enhancement. The implications are for the academicians and practitioners to undertake future research agenda emphasizing IC contribution in the sustainable development of the health care sector

Business strategy and earnings management: financial versus non-financial firms

This study investigates the impact of business strategy on earnings management practices for financial and non-financial firms in Oman. To assess the research objective, 430 firm-year observations from 2015 to 2019 were employed in the study. Using regression analysis, the findings suggest that differentiation strategy positively affects earnings management in financial sector firms. In addition, cost leadership strategy positively affects earnings management in non-financial sector firms. This indicates that business strategy is associated with company leaders managing their earnings while they are trying to survive through competition. These findings are useful for regulators, as they can introduce mechanisms to curb earnings management practices and instil more faith in investors

Comparative evaluation of INNO-LiPA HBV assay, direct DNA sequencing and subtractive PCR-RFLP for genotyping of clinical HBV isolates

Genotypes (A to H) of hepatitis B virus (HBV) influence liver disease progression and response to antiviral therapy in HBV-infected patients. Several methods have been developed for rapid genotyping of HBV strains. However, some of these methods may not be suitable for developing countries. The performance of INNO-LiPA HBV Genotyping assay (LiPA), direct DNA sequencing and subtractive PCR-RFLP of genotype-specific HBV genome regions were evaluated for accurately determining the HBV genotypes by analyzing sera (n = 80) samples from chronic HBV patients. Both, LiPA and DNA sequencing identified 63, 4 and 13 HBV strains as belonging to genotype D, genotype A and mixed genotype A and D, respectively. On the contrary, the PCR-RFLP-based method correctly identified all 4 genotype A but only 56 of 63 genotype D strains. Seven genotype D strains yielded indeterminate results. DNA sequence comparisons showed that a single nucleotide change in the target region generated an additional restriction site for Nla IV that compromised the accuracy of this method. Furthermore, all the mixed genotype A and D strains were identified only as genotype A strains. The data show that the PCR-RFLP-based method incorrectly identified some genotype D strains and failed to identify mixed genotype infections while LiPA and DNA sequencing yielded accurate results