15 results found
Deputy M, Rao C, Worley G, et al., 2021, Effect of the SARS-CoV-2 pandemic on mortality related to high-risk emergency and major elective surgery, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 754-759, ISSN: 0007-1323
Balinskaite V, Aylin P, Bottle R, 2021, Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors’ changeover, BMC Health Services Research, Vol: 21, Pages: 1-7, ISSN: 1472-6963
BackgroundTo assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work.MethodsData on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality.ResultsThere were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme.ConclusionThere was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.
Balinskaite V, 2019, The association between the referendum for withdrawal from the EU and the health-care workforce in England: an interrupted time series, Public Health Science Conference, Publisher: Elsevier, ISSN: 0140-6736
Balinskaite V, 2019, Trends and geographical variation in antidepressant prescribing in primary care in England: a descriptive analysis, Public Health Science Conference, Publisher: Elsevier, ISSN: 0140-6736
Balinskaite V, Bou-Antoun S, Johnson AP, et al., 2019, An assessment of potential unintended consequences following a national antimicrobial stewardship programme in England: an interrupted time series analysis, Clinical Infectious Diseases, Vol: 69, Pages: 233-242, ISSN: 1058-4838
Background: The 'Quality Premium' (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP. Methods: Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of pre-defined conditions of unintended consequences of reduced prescribing. Monthly age and sex-standardised rates were calculated using a direct method of standardisation. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates. Results: We identified 27,334 GP consultations and over five million emergency hospital admissions with pre-defined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions. Conclusions: Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.
Balinskaite V, Johnson AP, Holmes A, et al., 2019, The impact of a national antimicrobial stewardship programme on antibiotic prescribing in primary care: an interrupted time series analysis, Clinical Infectious Diseases, Vol: 69, Pages: 227-232, ISSN: 1058-4838
Background: The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods: We used a national antibiotic prescribing dataset from April 2013 till February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (Specific Therapeutic Group Age-sex Related Prescribing Units), the number of broad-spectrum antibiotic items prescribed and broad-spectrum antibiotic items prescribed expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results: During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5,933,563 fewer antibiotic items prescribed during the 23 post-intervention months compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions: This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.
Balinskaite V, Holmes A, Johnson A, et al., 2018, The Impact of a National Antimicrobial Stewardship Programmes on Antibiotic Prescribing in Primary Care in England: An Interrupted Time Series Analysis, ISQua, Publisher: OXFORD UNIV PRESS, Pages: 37-38, ISSN: 1353-4505
Balinskaite V, Holmes A, Johnson A, et al., 2018, An Assessment of Unintended Consequences in England Following a National Antimicrobial Stewardship Programme: An Interrupted Time Series Analysis, ISQua, Publisher: OXFORD UNIV PRESS, Pages: 37-37, ISSN: 1353-4505
Balinskaite V, Bottle A, Shaw LJ, et al., 2018, Reorganisation of stroke care and impact on mortality in patients admitted during weekends: a national descriptive study based on administrative data, BMJ Quality and Safety, Vol: 27, Pages: 611-618, ISSN: 2044-5415
OBJECTIVE: To evaluate mortality differences between weekend and weekday emergency stroke admissions in England over time, and in particular, whether a reconfiguration of stroke services in Greater London was associated with a change in this mortality difference. DESIGN, SETTING AND PARTICIPANTS: Risk-adjusted difference-in-difference time trend analysis using hospital administrative data. All emergency patients with stroke admitted to English hospitals from 1 January 2008 to 31 December 2014 were included. MAIN OUTCOMES: Mortality difference between weekend and weekday emergency stroke admissions. RESULTS: We identified 507 169 emergency stroke admissions: 26% of these occurred during the weekend. The 7-day in-hospital mortality difference between weekend and weekday admissions declined across England throughout the study period. In Greater London, where the reorganisation of stroke services took place, an adjusted 28% (relative risk (RR)=1.28, 95% CI 1.09 to 1.47) higher weekend/weekday 7-day mortality ratio in 2008 declined to a non-significant 9% higher risk (RR=1.09, 95% CI 0.91 to 1.32) in 2014. For the rest of England, a 15% (RR=1.15, 95% CI 1.09 to 1.22) higher weekend/weekday 7-day mortality ratio in 2008 declined to a non-significant 3% higher risk (RR=1.03, 95% CI 0.97 to 1.10) in 2014. During the same period, in Greater London an adjusted 12% (RR=1.12, 95% CI 1.00 to 1.26) weekend/weekday 30-day mortality ratio in 2008 slightly increased to 14% (RR=1.14, 95% CI 1.00 to 1.30); however, it was not significant. In the rest of England, an 11% (RR=1.11, 95% CI 1.07 to 1.15) higher weekend/weekday 30-day mortality ratio declined to a non-significant 4% higher risk (RR=1.04, 95% CI 0.99 to 1.09) in 2014. We found no statistically significant association between decreases in the weekend/weekday admissions difference in mortality and the centralisation of stroke services in Greater London. CONCLUSIONS: There was a steady reduction in weekend/weekday differences i
Balinskaite V, Bottle R, Sodhi V, et al., 2017, The risk of adverse pregnancy outcomes following non-obstetric surgery during pregnancy. Estimates from a retrospective cohort study of 6.5 million pregnancies, Annals of Surgery, Vol: 266, Pages: 260-266, ISSN: 1528-1140
Objective. To estimate the risk of adverse birth outcomes for women who underwent non-obstetric surgery during pregnancy compared with those who did not. Background. Previous research suggests that non-obstetric surgery occurs during 1%-2% of pregnancies. However, there is limited evidence quantifying risks to the mother or pregnancy of such surgery. Methods. We examined maternity admissions using hospital administrative data collected between 1st April 2002 and 31st March 2012 and identified pregnancies where non-obstetric surgery occurred. We used logistic regression models to determine the adjusted relative risk, attributable risk and number needed to harm of non-obstetric surgical procedures for adverse birth outcomes.Results. We identified 6,486,280 pregnancies. In 47,628 of these pregnancies, non-obstetric surgery had occurred. We found that non-obstetric surgery during pregnancy was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that every 287 surgical operations were associated with one additional stillbirth, every 31 operations associated with one additional preterm delivery, every 39 operations associated with one additional low birth weight baby, every 25 operations associated with one additional caesarean section, and every 50 operations associated with one additional long inpatient stay.Conclusions. Although we have no means of disentangling the effect of the surgery from the effect of the underlying condition, we found that the risk associated with non-obstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe. We believe that our findings improve upon previous research, and are useful reference points for any discussion of risk with prospective patients.
Balinskaite V, Bottle A, Aylin P, 2016, THE ASSOCIATION BETWEEN WEEKEND/WEEKDAY IN-HOSPITAL MORTALITY AND CENTRALISATION OF STROKE SERVICES, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 28, Pages: 16-16, ISSN: 1353-4505
Balinskaite V, Aylin P, Bennett P, et al., 2016, Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study, Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study, Publisher: NIHR Journals Library
Background:Previous research suggests that non-obstetric surgery is carried out in 1–2% of allpregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of theevidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelinesregarding non-obstetric surgery in pregnant women.Objectives:To estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgerywas or was not carried out. To further analyse common procedure groups.Data Source:Hospital Episode Statistics (HES) maternity data collected between 2002–3 and 2011–12.Main outcomes:Spontaneous abortion, preterm delivery, maternal death, caesarean delivery, longinpatient stay, stillbirth and low birthweight.Methods:We utilised HES, an administrative database that includes records of all patient admissions andday cases in all English NHS hospitals. We analysed HES maternity data collected between 2002–3 and2011–12, and identified pregnancies in which non-obstetric surgery was carried out. We used logisticregression models to determine the adjusted relative risk and attributable risk of non-obstetric surgicalprocedures for adverse birth outcomes and the number needed to harm.Results:We identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out.In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgerywas associated with a higher risk of adverse birth outcomes, although the attributable risk was generallylow. We estimated that for every 287 pregnancies in which a surgical operation was carried out there wasone additional stillbirth; for every 31 operations there was one additional preterm delivery; for every25 operations there was one additional caesarean section; for every 50 operations there was oneadditional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby.Limitations:We
Aylin P, Bennett P, Bottle A, et al., 2016, The risk of adverse pregnancy outcomes following non-obstetric surgery during pregnancy: An observational study, BJOG-An International Journal of Obstetrics and Gynaecology, Vol: 123, Pages: 84-84, ISSN: 1471-0528
Balinskaite V, Laurincikas A, 2008, A Two-Dimentional Discrete Limit Theorem in the Space of Analytic Functions for Mellin Transforms of the Riemann Zeta-Function, NONLINEAR ANALYSIS-MODELLING AND CONTROL, Vol: 13, Pages: 159-167, ISSN: 1392-5113
Balinskaite V, Laurincikas A, 2008, Discrete limit theorems for the Mellin transform of the Riemann zeta-function, ACTA ARITHMETICA, Vol: 131, Pages: 29-42, ISSN: 0065-1036
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.