Abstract:
OBJECTIVES:To investigate whether routinely collected data from hospital episode statistics could be used to identify the gynaecologist Rodney Ledward, who was suspended in 1966 and was the subject of the Ritchie inquiry into quality and practice within the NHS. DESIGN:A mixed scanning approach was used to identify seven variables from hospital episode statistics that were likely to be associated with potentially poor performance. A blinded multivariate analysis was undertaken to determine the distance (known as the Mahalanobis distance) in the seven indicator multidimensional space that each consultant was from the average consultant in each year. The change in Mahalanobis distance over time was also investigated by using a mixed effects model. SETTING:NHS hospital trusts in two English regions, in the five years from 1991-2 to 1995-6. Population Gynaecology consultants (n = 143) and their hospital episode statistics data. MAIN OUTCOME MEASURE:Whether Ledward was a statistical outlier at the 95% level. RESULTS:The proportion of consultants who were outliers in any one year (at the 95% significance level) ranged from 9% to 20%. Ledward appeared as an outlier in three of the five years. Our mixed effects (multi-year) model identified nine high outlier consultants, including Ledward. CONCLUSION:It was possible to identify Ledward as an outlier by using hospital episode statistics data. Although our method found other outlier consultants, we strongly caution that these outliers should not be overinterpreted as indicative of "poor" performance. Instead, a scientific search for a credible explanation should be undertaken, but this was outside the remit of our study. The set of indicators used means that cancer specialists, for example, are likely to have high values for several indicators, and the approach needs to be refined to deal with case mix variation. Even after allowing for that, the interpretation of outlier status is still as yet unclear. Further prospective evaluation of our method is warranted, but our overall approach may be potentially useful in other settings, especially where performance entails several indicator variables.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Harley M,Mohammed MA,Hussain S,Yates J,Almasri Adoi
10.1136/bmj.38377.675440.8Fkeywords:
subject
Has Abstractpub_date
2005-04-23 00:00:00pages
929issue
7497eissn
0959-8138issn
1756-1833pii
bmj.38377.675440.8Fjournal_volume
330pub_type
杂志文章,多中心研究abstract::Hepatorenal syndrome (HRS), the extreme manifestation of renal impairment in patients with cirrhosis, is characterized by reduction in renal blood flow and glomerular filtration rate. Hepatorenal syndrome is diagnosed when kidney function is reduced but evidence of intrinsic kidney disease, such as hematuria, proteinu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.m2687
更新日期:2020-09-14 00:00:00
abstract:OBJECTIVE: To identify and characterise non-specific immunological effects after routine childhood vaccines against BCG, measles, diphtheria, pertussis, and tetanus. DESIGN: Systematic review of randomised controlled trials, cohort studies, and case-control studies. DATA SOURCES: Embase, PubMed, Cochrane library, and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i5225
更新日期:2016-10-13 00:00:00
abstract::Chronic insomnia is a common condition that affects people worldwide and has negative effects on patients' health and wellbeing. The treatment of insomnia can be complex and time consuming for patients and providers. Although behavioral interventions are the first line therapy, there are barriers to access for these t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.i2123
更新日期:2016-07-06 00:00:00
abstract:OBJECTIVE:To investigate the differences between skeletal and chronological age and to assess the role of maturity status, anthropometric data, and football related variables in explaining injury statistics in elite schoolboy footballers. DESIGN:Prospective study of injuries in schoolboy footballers according to skele...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b490
更新日期:2009-02-26 00:00:00
abstract:OBJECTIVES:To assess the acceptability of screening newborn boys for Duchenne muscular dystrophy. DESIGN:Screening is offered on the basis of informed consent in response to an information sheet entitled "A new test for baby boys--Do you want it?" The programme includes a prospective long term evaluation of family res...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6874.357
更新日期:1993-02-06 00:00:00
abstract:OBJECTIVE:To investigate the results of resuscitation of patients with cardiac arrest by ambulance staff with extended training in West Yorkshire. DESIGN:Study of all such attempts at resuscitation over 32 months, based on the standard report form for each call made by the ambulance staff and the electrocardiogram tha...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6752.600
更新日期:1990-09-22 00:00:00
abstract:OBJECTIVE:To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash. DESIGN:Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months. SETTING:Patients referred from primary care. SUBJECTS:117 patients (mean age...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6905.652
更新日期:1993-09-11 00:00:00
abstract:OBJECTIVE:To derive and validate an algorithm to estimate the absolute risk of having ovarian cancer in women with and without symptoms. DESIGN:Cohort study with data from 375 UK QResearch general practices for development and 189 for validation. PARTICIPANTS:Women aged 30-84 without a diagnosis of ovarian cancer at ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d8009
更新日期:2011-01-04 00:00:00
abstract::An association between vasectomy and the development of testicular tumors, and the importance of testicular examinations both before and after a vasectomy is discussed. Patients diagnosed with testicular tumors within the last ten years were examined at Bangour General Hospital in Scotland. From 1977-87, 37 patients...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6721.370
更新日期:1990-02-10 00:00:00
abstract:OBJECTIVE:To examine the association between warfarin treatment and longitudinal outcomes after ischemic stroke in patients with atrial fibrillation in community practice. DESIGN:Observational study. SETTING:Hospitals (n = 1487) participating in the Get With The Guidelines (GWTG)-Stroke program in the United States, ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h3786
更新日期:2015-07-31 00:00:00
abstract:OBJECTIVE:To investigate any long term effects of traumatic birth and obstetric procedures in relation to suicide by violent means in offspring as adults. DESIGN:Prospective case-control study. SETTING:Stockholm, Sweden. SUBJECTS:242 adults who committed suicide by violent means from 1978 to 1995, and who were born ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7169.1346
更新日期:1998-11-14 00:00:00
abstract:OBJECTIVE:To determine whether the link suggested between growth in utero and during infancy and death from cardiovascular disease in men is also present in women. DESIGN:Follow up study of women and men whose birth weight and weight at 1 year of age had been recorded. SETTING:Hertfordshire, England. SUBJECTS:5585 w...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6918.1519
更新日期:1993-12-11 00:00:00
abstract:OBJECTIVE:To investigate the effect of overweight on premature mortality and work disability in young and middle aged Finns. DESIGN:Prospective cohort study based on data collected in the multiphasic health examinations by the Social Insurance Institution of Finland from 1966 to 1972 and follow up until 1982. SETTING...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.301.6756.835
更新日期:1990-10-13 00:00:00
abstract:OBJECTIVE:To determine whether the increased iron demands of pregnancy could be met by increased absorption from dietary sources. DESIGN AND SETTING:Longitudinal prospective study in the research unit of a maternity hospital. SUBJECTS:12 normal pregnant women. INTERVENTIONS:At 12, 24, and 36 weeks' gestation (within...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6947.79
更新日期:1994-07-09 00:00:00
abstract:OBJECTIVE:To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in med...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d199
更新日期:2011-02-03 00:00:00
abstract:OBJECTIVE:To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN:Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING:England and Wales. SUBJECTS:Children aged 0-15 years. MAIN OU...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7060.784
更新日期:1996-09-28 00:00:00
abstract:OBJECTIVE:To examine the extent to which changes in diagnostic methods and classification are responsible for the striking increase in incidence of primary liver cancer in Denmark since 1943. DESIGN:Analysis of the time trends in sex specific, age standardised incidence of primary liver cancer and unspecified liver ca...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6774.437
更新日期:1991-02-23 00:00:00
abstract:OBJECTIVE:To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia. DESIGN:Multisite single blind randomised controlled trial. SETTING:Diverse services at fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.e2233
更新日期:2012-04-05 00:00:00
abstract:OBJECTIVE:To determine whether rates of suicide changed in Toronto after a barrier was erected at Bloor Street Viaduct, the bridge with the world's second highest annual rate of suicide by jumping after Golden Gate Bridge in San Francisco. DESIGN:Natural experiment. SETTING:City of Toronto and province of Ontario, Ca...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.c2884
更新日期:2010-07-06 00:00:00
abstract::Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammograph...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j5224
更新日期:2017-12-05 00:00:00
abstract::Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids wi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.l1114
更新日期:2019-05-29 00:00:00
abstract:OBJECTIVES:To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments. DESIGN:Blinded randomised controlled trial. SETTING:13 general practices in Exeter, Devon. SUBJECTS:2078 new consultant referrals from 26 doctors. MAIN OUTCOME MEASURES:Non-attenda...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.318.7195.1392
更新日期:1999-05-22 00:00:00
abstract::A total of 22,552 workers employed by the Atomic Weapons Establishment between 1951 and 1982 were followed up for an average of 18.6 years. Of the 3115 who died, 865 (28%) died of cancer. Mortality was 23% lower than the national average for all causes of death and 18% lower for cancer. These low rates were consistent...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6651.757
更新日期:1988-09-24 00:00:00
abstract:OBJECTIVE:To determine the relative contribution of decline in bone density to the increase in risk of hip fracture with age in men and women. DESIGN:Incidence data of hip fracture from the general population were combined with the bone density distribution in a sample from the same population and with a risk estimate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7102.221
更新日期:1997-07-26 00:00:00
abstract:OBJECTIVE:To compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty. DESIGN:Randomised trial with blinding of assessments of functional results. SETTING:University hospital. PARTICIPANTS:222 patients; 165 (74%) women, mean age 83 years. Inclusi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.39399.456551.25
更新日期:2007-12-15 00:00:00
abstract:OBJECTIVE:To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke. DESIGN:Randomised crossover trial comparing two groups offered intervention by a physiotherapist, one immediately after entry into the trial and the other after a delay of three mont...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.304.6827.609
更新日期:1992-03-07 00:00:00
abstract:OBJECTIVE:To find out what inpatients with advanced cancer who are receiving palliative care think about the effect of thromoprophylaxis on overall quality of life. DESIGN:Qualitative study using audiotaping of semistructured interviews. SETTING:Regional cancer centre in Wales. PARTICIPANTS:28 inpatients with advanc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38733.616065.802
更新日期:2006-03-11 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community. DESIGN:Pragmatic multicentre, two arm, parallel group, randomised controlled trial. SETTING:2...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.h3830
更新日期:2015-07-22 00:00:00
abstract::Organs for donation are in short supply in the United Kingdom, resulting in allegations that relatives of potential donors are not being asked for consent. Legislation on "required request" has been proposed to overcome this. The incidence, causes, complications, and patterns of organ donation in brain stem dead patie...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6706.1009
更新日期:1989-10-21 00:00:00
abstract::Care in the community for insane people today is more a matter of expert provision than communal support. In consequence, although they are no longer confined to hospital, mentally ill people largely remain marginalised in a society that does not have the resources, nor often the inclination, to take responsibility fo...
journal_title:BMJ (Clinical research ed.)
pub_type: 历史文章,杂志文章
doi:10.1136/bmj.311.7021.1708
更新日期:1995-12-23 00:00:00