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P Aylin

Publications and source records attributed to P Aylin.

11 recordsLinked to original sources
PubMed2006

Descriptive study comparing routine hospital administrative data with the Vascular Society of Great Britain and Ireland's National Vascular Database.

OBJECTIVE: To compare patient volume and outcomes in vascular surgery between an administrative data set (Hospital Episode Statistics) and a clinical database (National Vascular Database). DESIGN: Descriptive study. METHODS: Volume of cases determined by age, sex, year and procedure and in-hospital mortality by procedure for both datasets for patients undergoing either repair of abdominal aortic aneurysm, carotid endarterectomy or infrainguinal bypass over a three year period between 1st April 2001 and 31st March 2004. RESULTS: There were 32,242 admissions with a mention of the three selected vascular procedures within the administrative data set compared to 8462 within the clinical database. For NHS trusts common to both datasets, there were twice as many procedures (16,923) recorded within the administrative dataset compared to the clinical database. Patient characteristics were similar across both databases. Further analysis limiting the administrative data to records attributed to consultants known to contribute to the clinical database showed much closer agreement with only 11% more repairs of abdominal aortic aneurysm recorded within the administrative dataset compared to the National Vascular Database. CONCLUSIONS: There are significant differences in total numbers between HES and the NVD. If the National Vascular Database is to become a credible source of information on activity and outcomes for vascular surgery, there is a clear need to increase the number of contributing surgeons and to increase the completeness of data submitted. Further analysis at individual record level is needed to identify other reasons for discrepancies which could help to enhance data quality, both within Hospital Episode Statistics and within the National Vascular Database.

Adult↗
PubMed2001

Comparison of UK paediatric cardiac surgical performance by analysis of routinely collected data 1984-96: was Bristol an outlier?

BACKGROUND: Reports of high mortality after paediatric cardiac surgery at the Bristol Royal Infirmary, UK, led to the establishment of an independent public inquiry. A key question was whether or not the mortality statistics in Bristol were unusual compared with other specialist centres. To answer this question, we did a retrospective analysis of mortality in the UK using two datasets. METHODS: Data from the UK Cardiac Surgical Register (CSR; January, 1984, to March, 1996) and Hospital Episode Statistics (HES; April, 1991, to December, 1995) were obtained for all 12 major centres in which paediatric cardiac surgery is done in the UK. The main outcome measure was mortality within 30 days of a cardiac surgical procedure. We estimated excess deaths in Bristol using a random-effects model derived from the remaining 11 centres. Additionally, a sensitivity analysis was done and case-mix examined. FINDINGS: For children younger than 1 year, in open operations, the mortality rate in Bristol was around double that of the other centres during 1991-95: within the CSR, there were 19.0 excess deaths (95% interval 2-32) among 43 deaths; and in HES, there were 24.1 excess deaths (12-34) among 41 deaths recorded. There was no strong evidence for excess mortality in Bristol for closed operations or for open operations in children older than 1 year. INTERPRETATION: Our results suggest that Bristol was an outlier, and we do not believe that statistical variation, systematic bias in data collection, case-mix, or data quality can explain a divergence in performance of this size.

Adolescent↗
PubMed2001

Temperature, housing, deprivation and their relationship to excess winter mortality in Great Britain, 1986-1996.

OBJECTIVES: To examine the associations between temperature, housing, deprivation and excess winter mortality using census variables as proxies for housing conditions. DESIGN: Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996. PARTICIPANTS: Men and women aged 65 and over. MAIN OUTCOME MEASURES: Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (ICD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-519). Odds of death occurring in winter period of the four months December to March compared to the rest of the year. RESULTS: During the study period (excluding the influenza epidemic year of 1989/90), a total of 1,682,687 deaths occurred in winter and 2,825,223 deaths occurred during the rest of the year among people aged > or =65 (around 30,000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categories (P < 0.01). There was a significant association between winter mortality and temperature with a 1.5% higher odds of dying in winter for every 1 degrees C reduction in 24-h mean winter temperature. The amount of rain, wind and hours of sunshine were inversely associated with excess winter mortality. Selected housing variables derived from the English House Condition Survey showed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation and excess winter mortality, although lack of central heating was associated with a higher risk of dying in winter (odds ratio [OR] = 1.016, 95% CI : 1.009-1.022). CONCLUSIONS: Excess winter mortality continues to be an important public health problem in Great Britain. There was a strong inverse association with temperature. Lack of central heating was associated with higher excess winter mortality. Further work is needed to disentangle the complex relationships between different indicators of housing quality and other measures of socioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.

Aged↗
PubMed2001

Accessing and using hospital activity data.

Hospital activity data can be accessed from a variety of sources ranging from hospitals to the Department of Health. These data provide valuable and widely used information, but care is needed in their use and interpretation. Hospital activity rates reflect not only the underlying prevalence and severity of disease, individual factors and referral practices, but also variations related to provider-specific factors: the 'provider effect'. This includes completeness in the data, supply of hospital beds, admission policies, hospital access and distance from hospital. The provider effect can be controlled to a certain extent in statistical analyses. Although data quality has improved considerably in the last decade, this should still be investigated where trusts are being compared and in small area studies because missing data may lead to artefactual differences in rates. 'Dump' postcodes, where missing or unknown postcodes are assigned to a local postcode such as that of the hospital, may affect small area analyses and linkage if a proxy patient identifier is constructed that includes postcode.

Data Collection↗
PubMed2001

Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales.

BACKGROUND: The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated. METHODS: A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age. RESULTS: At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90 to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma. CONCLUSIONS: No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.

Aged↗
PubMed1999

A national facility for small area disease mapping and rapid initial assessment of apparent disease clusters around a point source: the UK Small Area Health Statistics Unit.

BACKGROUND: Reports of disease clusters are often received by district health authorities and are, in some cases, associated with concerns about a pollution source. The Small Area Health Statistics Unit (SAHSU) has developed a Rapid Inquiry Facility, which will produce an estimated relative risk for any given condition for the population within defined areas around a point source, relative to the population in a local reference region. The system can also facilitate the production of annual reports and other health studies for Departments of Public Health Medicine through the creation of ward-level maps to illustrate disease variation across small areas. METHODS: The facility uses routinely collected morbidity, mortality and population data at a small area scale, together with the computing facilities and expertise necessary to run such analyses quickly and efficiently. Using this facility SAHSU can supply a report within three working days. To aid interpretation, smoothed small area maps that account for sampling variability in the observed data can also be produced. RESULTS: The paper reports on two case studies where the pilot system has been utilized by health authorities for both point source analyses and small area disease mapping. CONCLUSIONS: We believe that this facility would be of considerable use to districts. The local knowledge and expertise of the local public health specialist is essential in the interpretation and presentation of the facility's output. Feedback from public health specialists is helping SAHSU refine the output of the facility, so as to make the information presented as comprehensive and as useful as possible.

Data Interpretation, Statistical↗
PubMed1996

Home visiting by general practitioners in England and Wales.

OBJECTIVE: To use data from the fourth national survey of morbidity in general practice to investigate the association between home visiting rates and patients' characteristics. DESIGN: Survey of diagnostic data on all home visits by general practitioners. SETTING: 60 general practices in England and Wales. SUBJECTS: 502 493 patients visited at home between September 1991 and August 1992. MAIN OUTCOME MEASURES: Home visiting rates per 1000 patient years and home visiting ratios standardised for age and sex. RESULTS: 10.1% (139 801/1 378 510) of contacts with general practitioners took place in patients' homes. The average annual home visiting rate was 299/1000 patient years. Rates showed a J shaped relation with age and were lowest in people aged 16-24 years (103/1000) and highest in people aged > or = 85 years (3009/1000). 1.3% of patients were visited five or more times and received 39% of visits. Age and sex standardised home visiting ratios increased from 69 (95% confidence interval 68 to 70) in social class I to 129 (128 to 130) in social class V. The commonest diagnostic group was diseases of the respiratory system. In older age groups, diseases of the circulatory system was also a common diagnostic group. Standardised home visiting ratios for the 60 practices in the study varied nearly eightfold, from 28 to 218 (interquartile range 67 to 126). CONCLUSIONS: Home visits remain an important component of general practitioners' workload. As well as the strong associations between home visiting rates and patient characteristics, there were also large differences between practices in home visiting rates. A small number of patients received a disproportionately high number of home visits. Further investigation of patients with high home visiting rates may help to explain the large differences in workload between general practices and help in allocation of resources to practices.

Adolescent↗
PubMed1996

Death certification: production and evaluation of a training video.

The purpose of this study was to produce an effective training video on death certification suitable for use by medical students and postgraduates. A 15-minute video was commissioned from a video production unit and two authors (PA and CP) provided advice and support in the process of script writing and production. An evaluation by means of a randomized controlled trial took place among 185 first year medical students at the University of Leicester. The video was shown as an addition to the usual lecture on death certification. Performance in a test of knowledge, skill and motivation was recorded in each of the two groups. Students assigned to see the video scored slightly better overall in a test of knowledge and skill (difference in medians = 3, in a test marked out of 68, P = 0.046). The intervention group also gave a significantly higher priority to avoiding distress caused to relatives as a reason for certifying death accurately (60% vs. 35%, difference in proportions = 24%, P = 0.002). There was no evidence that enjoyment or views about the nature or content of the video had an impact on performance in the test. It is concluded that adding the video to the usual lecture had a limited effect on the overall knowledge and skills of undergraduate students but was highly effective in conveying the message that inaccurate death certification can cause distress to relatives. The randomized controlled trial is a practical and simple means of evaluating teaching methods for medical undergraduates.

Death Certificates↗
PubMed1996

Increasing mortality from Creutzfeldt-Jakob disease in England and Wales since 1979: ascertainment bias from increase in post-mortems?

Creutzfeldt-Jakob disease (CJD) is a rare and fatal dementing illness. A direct link has been proposed between cattle infected with bovine spongiform encephalopathy (BSE) and a newly-identified variant of CJD. One possible explanation for the emergence of this new variant, together with a general increase in death due to classical CJD, would be ascertainment bias, due to an increase in the frequency of post-mortems in death attributed to dementia. This article uses national mortality records to look at trends in the proportion of deaths due to dementing illnesses for which a post-mortems was carried out. The results show an increase in deaths due to both CJD and other dementing illnesses, but a slight decrease in the proportion of post-mortems. We conclude that an increase in post-mortems is unlikely to explain the increase in deaths certified as due to CJD. Similarly, the appearance of the new variant of CJD since 1994 cannot easily be attributed to this form of ascertainment bias, in line with the conclusion reached by the Spongiform Encephalopathy Advisory Committee in March 1996.

Adult↗