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British Medical Journal (british + medical_journal)
Selected AbstractsA MASTER CLASS IN UNDERSTANDING VARIATIONS IN HEALTHCARECYTOPATHOLOGY, Issue 2006M. Mohammed That there is wide-spread variation in healthcare outcomes cannot be denied. The question is what does the variation mean and what can we do about it? Using a series of well-known case-studies, which include data from the Bristol and Shipman Inquiries, fundamental limitations of traditional methods of understanding variation will be highlighted. These methods, which include comparison with standards, league tables and statistical testing, have flaws and they offer little or no guidance on how to re-act to the variation. Fortunately, there is a theory of variation that overcomes these limitations and provides useful guidance on re-acting to variation, which was developed by Walter Shewhart in the 1920s in an industrial setting. Shewhart's theory of variation found widespread application and won him the accolade ,Father of modern quality control'. His work is central to philosophies of continual improvement. Application of Shewhart's theory of variation, also known as Statistical Process Control (SPC), to case-studies from healthcare will be demonstrated, whilst highlighting the implications and challenges for performance management/monitoring and continual improvement in the healthcare. References:, 1. M A Mohammed, KK Cheng, A Rouse, T Marshall. "Bristol, Shipman and clinical governance: Shewhart's forgotten lessons" The Lancet 2001; 357: 463,7. 2. P Adab, A Rouse, M A Mohammed, T Marshall. "Performance league tables: the NHS deserves better" British Medical Journal 2002; 324: 95,98 [source] Inconsistencies between reported test statistics and p- values in two psychiatry journalsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2007David Berle Abstract A recent survey of the British Medical Journal (BMJ) and Nature revealed that inconsistencies in reported statistics were common. We sought to replicate that survey in the psychiatry literature. We checked the consistency of reported t -test, F -test and ,2 -test values with their corresponding p -values in the 2005 issues of the Australian and New Zealand Journal of Psychiatry (ANZJP) and compared this with the issues of the ANZJP from 2000, and with a similar journal, Acta Psychiatrica Scandinavica (APS). A reported p -value was ,inconsistent' if it differed (at its reported number of decimal places) from our calculated p -values (using three different software packages), which we based on the reported test statistic and degrees of freedom. Of the 546 results that we checked, 78 (14.3%) of the p -values were inconsistent with the corresponding degrees of freedom and test statistic. Similar rates of inconsistency were found in APS and ANZJP, and when comparing the ANZJP between 2000 and 2005. The percentages of articles with at least one inconsistency were 8.5% for ANZJP 2005, 9.9% for ANZJP 2000 and 12.1% for APS. We conclude that inconsistencies in p -values are common and may reflect errors of analysis and rounding, typographic errors or typesetting errors. Suggestions for reducing the occurrence of such inconsistencies are provided. Copyright © 2008 John Wiley & Sons, Ltd. [source] Early head injury and attention deficit hyperactivity disorder: retrospective cohort studyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2009Richard Reading Early head injury and attention deficit hyperactivity disorder: retrospective cohort study . KeenanH. T., HallG. C. & MarshallS.W. ( 2008 ) British Medical Journal , 337 , a1984 . DOI:10.1136/bmj.a1984 . Objective To explore the hypothesis that medically attended head injury in young children may be causal in the later development of attention deficit hyperactivity disorder. Design Retrospective cohort study. Setting Health improvement network database (1988,2003), a longitudinal UK general practice dataset. Participants All children registered in the database from birth until their 10th birthday. Main outcome measures Risk of a child with a head injury before age 2 developing attention deficit hyperactivity disorder before age 10 compared with children with a burn injury before age 2 and children with neither a burn nor a head injury. Results Of the 62 088 children who comprised the cohort, 2782 (4.5%) had a head injury and 1116 (1.8%) had a burn injury. The risk of diagnosis of attention deficit hyperactivity disorder before 10 years of age after adjustment for sex, prematurity, socio-economic status and practice identification number was similar in the head injury (relative risk 1.9, 95% confidence interval 1.5 to 2.5) and burn injury groups (1.7, 1.2 to 2.5) compared with all other children. Discussion Medically attended head injury before 2 years of age does not seem to be causal in the development of attention deficit hyperactivity disorder. Medically attended injury before 2 years of age may be a marker for subsequent diagnosis of attention deficit hyperactivity disorder. [source] Realist review to understand the efficacy of school feeding programmesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2008Richard Reading Realist review to understand the efficacy of school feeding programmes . GreenhalghT., KristjanssonE. & RobinsonV. ( 2007 ) British Medical Journal , 335 , 858 , 861 . DOI: 10.1136/bmj.39359.525174.AD. [source] Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trialCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2007Richard Reading Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial . Henderson, M., Wight, D., Raab, G. M., Abraham, C., Parkes, A., Scott, S. & Hart, G. ( 2007 ) British Medical Journal , 334 , 133 , 6 . DOI: 10.1136/bmj.39014.503692.55. Objective To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the National Health Service. Design Follow-up of cluster randomized trial 4.5 years after intervention. Setting National Health Service records of women who had attended 25 secondary schools in east Scotland. Participants A total of 4196 women (99.5% of those eligible). Intervention SHARE programme (intervention group) vs. existing sex education (control group). Main outcome measure National Health Service recorded conceptions and terminations for the achieved sample linked at age 20 years. Results In an ,intention to treat' analysis, there were no significant differences between the groups in registered conceptions per 1000 pupils (300 SHARE vs. 274 control; difference 26, 95% CI ,33 to 86) and terminations per 1000 pupils (127 vs. 112; difference 15, ,13 to 42) between ages 16 and 20 years. Conclusions This specially designed sex education programme did not reduce conceptions or terminations by age 20 years compared with conventional provision. The lack of effect was not due to quality of delivery. Enhancing teacher-led school sex education beyond conventional provision in eastern Scotland is unlikely to reduce terminations in teenagers. [source] Physical activity to prevent obesity in young children: cluster randomised controlled trialCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2007Richard Reading Physical activity to prevent obesity in young children: cluster randomised controlled trial . Reilly, J. J., Kelly, L., Montgomery, C., Williamson, A., Fisher, A., McColl, J. H., Lo Conte, R., Paton, J. Y. & Grant, S. ( 2006 ) British Medical Journal , 333 , 1041 DOI: 10.1136/bmj.38979.623773.55. Objective To assess whether a physical activity intervention reduces body mass index in young children. Design Cluster randomized controlled single blinded trial over 12 months. Setting Thirty-six nurseries in Glasgow, Scotland. Participants In total, 545 children in their pre-school year, mean age 4.2 years (SD 0.2) at baseline. Intervention Enhanced physical activity programme in nursery (three 30-minute sessions a week over 24 weeks) plus home-based health education aimed at increasing physical activity through play and reducing sedentary behaviour. Main outcome measure Body mass index, expressed as a standard deviation score relative to UK 1990 reference data. Secondary measures were objectively measured physical activity and sedentary behaviour; fundamental movement skills; and evaluation of the process. Results Group allocation had no significant effect on the primary outcome measure at 6 and 12 months or on measures of physical activity and sedentary behaviour by accelerometry. Children in the intervention group had significantly higher performance in movement skills tests than control children at 6-month follow-up (P = 0.0027; 95% CI 0.3,1.3) after adjustment for sex and baseline performance. Conclusions Physical activity can significantly improve motor skills but did not reduce body mass index in young children in this trial. [source] | ||||||||||