Development of auditing in Malaysia: Legal, political and historical influences

This work investigates the role and contribution of external auditing as practised in the Malaysian society during the forty year period from independence in 1957 to just before the onset of the Asian Financial Crisis in 1997.It applies the political economic theory introduced by Tinker (1980) and refined by Cooper & Sherer (1984), which focuses on the social relations aspects of professional activity rather than economic forces alone.In a case study format where qualitative data was gathered mainly from primary and secondary source materials, the study found that the function of auditing in the Malaysian society in most cases is devoid of any essence of mission; instead it is created, shaped and transformed by the pressures which give rise to its development over time.The largely insignificant role that it serves is intertwined within the contexts in which it operates

Psychosocial outcomes in pediatric patients with ventricular assist devices and their families: A systematic review

Ventricular assist device (VAD) therapy has provided pediatric patients with severe heart failure new therapeutic options. However, pediatric patients and families receiving VAD therapy also experience psychosocial challenges. No synthesis of the literature on psychosocial outcomes within the pediatric VAD population has been conducted; thus, the current review sought to systematically investigate the impact of pediatric VAD on patient, parent, and family psychosocial outcomes and assess variables associated with poorer outcomes. Literature searches were conducted in PsycInfo, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases and full texts were assessed according to pre‐established inclusion criteria. Main findings and study quality were reviewed. Sixteen studies were included in the present review. Findings highlighted the likelihood for psychological sequelae among pediatric patients and families receiving VAD therapy, including decreased psychological and emotional well‐being, elevated stress, and difficulty coping with changes to family dynamics and responsibilities. Health‐related quality of life was reported comparable to that of healthy peers and children with other cardiac conditions. Patients and families on VAD therapy experience significant difficulties in psychological well‐being and challenges related to adjustment. The current review underscores the importance of ongoing support for families and continued assessment of psychosocial functioning across VAD support. Three critical periods for increased distress were identified: 1) immediately following VAD implantation, 2) discharge home and the weeks following discharge, and 3) long‐term VAD therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167822/1/petr14001_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167822/2/petr14001.pd

Burnout, professional fulfillment, and post‐traumatic stress among pediatric solid organ transplant teams

BackgroundAdverse effects of clinician burnout have been studied across multiple specialties; however, there have been no studies examining rates of burnout among pediatric solid organ transplant teams. This study aimed to measure burnout, work exhaustion, professional fulfillment, and post‐traumatic stress symptoms among clinicians and administrators practicing in this high‐stress field.MethodsThis cross‐sectional study utilized a 50 item web‐based survey that included the Personal Fulfillment Index and the IES‐R. This survey was distributed across four pediatric solid organ transplant centers in North America. Basic demographics, clinician characteristics, and information regarding wellness and self‐care activities were collected. Descriptive and correlational analyses were performed.ResultsOne hundred and thirty five participants completed the survey, 76% were female and 78% were Caucasian. One‐third (34%) of participants endorsed burnout, while 43% reported professional fulfillment. Approximately 15% of respondents endorsed clinically significant levels of post‐traumatic stress symptoms related to patient deaths, with female clinicians more likely to endorse symptoms (p = .01). Nearly 80% of participants reported engaging in self‐care activities outside of work and only 10% of participants reported participation in hospital‐sponsored wellness programs.ConclusionsPediatric solid organ transplant team members exhibited moderate levels of burnout, professional fulfillment, and post‐traumatic stress. Female clinicians were the most likely to experience both work exhaustion and post‐traumatic stress symptoms. Transplant centers are encouraged to consider interventions and programming to improve clinician wellness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/1/petr14020.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167846/2/petr14020_am.pd

Data-driven computational models of ventricular-arterial hemodynamics in pediatric pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a complex disease involving increased resistance in the pulmonary arteries and subsequent right ventricular (RV) remodeling. Ventricular-arterial interactions are fundamental to PAH pathophysiology but are rarely captured in computational models. It is important to identify metrics that capture and quantify these interactions to inform our understanding of this disease as well as potentially facilitate patient stratification. Towards this end, we developed and calibrated two multi-scale high-resolution closed-loop computational models using open-source software: a high-resolution arterial model implemented using CRIMSON, and a high-resolution ventricular model implemented using FEniCS. Models were constructed with clinical data including non-invasive imaging and invasive hemodynamic measurements from a cohort of pediatric PAH patients. A contribution of this work is the discussion of inconsistencies in anatomical and hemodynamic data routinely acquired in PAH patients. We proposed and implemented strategies to mitigate these inconsistencies, and subsequently use this data to inform and calibrate computational models of the ventricles and large arteries. Computational models based on adjusted clinical data were calibrated until the simulated results for the high-resolution arterial models matched within 10% of adjusted data consisting of pressure and flow, whereas the high-resolution ventricular models were calibrated until simulation results matched adjusted data of volume and pressure waveforms within 10%. A statistical analysis was performed to correlate numerous data-derived and model-derived metrics with clinically assessed disease severity. Several model-derived metrics were strongly correlated with clinically assessed disease severity, suggesting that computational models may aid in assessing PAH severity