Physician self-audit: a scoping review.

INTRODUCTION: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The purpose of this study was to identify how self-audit has been operationalized; factors influencing self-audit conduct and outcomes, including program design; and issues warranting further research. METHODS: A systematic review of quantitative and qualitative studies was undertaken. Two individuals independently reviewed searches of indexed literature databases, tables of contents, and references of eligible studies. Data were extracted and tabulated to describe the nature and impact of self-audit programs. RESULTS: Six studies evaluated the impact of self-audit programs. No program was based on a model or theory that informed its design. All studies showed improved compliance with care delivery guidelines and/or improved patient outcomes, although these findings were largely self-reported. Programs varied so features associated with benefit could not be identified. DISCUSSION: Overall there is a need for guidance on all aspects of self-audit for both participants and leaders. This guidance would be useful to educators, professional associations, and medical certification bodies to plan, develop, implement, evaluate, and support self-audit programs. Further research should aim at developing training programs and tools that address and evaluate a variety of competencies across different disciplines using more rigorous research designs, including both quantitative and qualitative approaches.

Accuracy of bladder scanning in the assessment of postvoid residual volume.

OBJECTIVE: To compare the accuracy of the 3D portable ultrasound with catheterization in the assessment of postvoid residual (PVR) urine volume among women in the urogynaecology clinic. METHODS: A prospective study was performed, assessing 101 women. After the patient voided four ultrasound (US) assessments were carried out using the BladderScan BVI 3000; the patient was then catheterized. The reproducibility of the US measurements and the difference between the two methods were assessed using Bland and Altman plots. The strength of the relationship was measured by a simple Pearson correlation coefficient. RESULTS: The results showed that 3D scanner measurements were highly reproducible and were also found to correlate significantly with catheterized volume (r=0.79, 95% CI 0.70-0.85, P<0.001). The mean difference between the two methods was 12.9 mL (95% CI 5.5-20.2 mL, P<0.001). CONCLUSION: In determining PVR volumes, the portable ultrasound BladderScan BVI 3000 is an accurate alternative to bladder catheterization.

Detailed account of confounding factors in interpretation of FTIR spectra of exfoliated cervical cells.

The confounding variables that can potentially lead to a misinterpretation of FTIR spectroscopy of exfoliated cervical cells is described. A detailed account of the spectral effects of the following variables in FTIR spectroscopic screening of exfoliated cervical cells is presented: polymorphs; Cell degradation; and impurities such as endocervical columnar cells, metaplastic cells, cervical mucus, red cells, and debris. The interpretation of the spectra of exfoliated cervical cells must be done with subtraction analysis, which includes these factors. This is essential to prevent unacceptable false-positive rates. The above techniques are subsequently applied to two clinic populations: a dysplasia clinic in follow-up patients with negative cytology and two general gynecology clinics with patients with negative cytology. In the dysplasia clinic group 250 sequential patients with negative smears were tested. Thirty had false-positive smears as defined by the IR spectroscopy using the above methodology. Twenty of those patients subsequently had one follow-up and six had a positive abnormal smear. In the community clinic group 656 sequential patients were examined who had negative smears, of which 27 had false-positive FTIR spectra.