Suchergebnisse

IntroductionWe report on service user participation in 'Births and their Outcomes', a population-based, retrospective, birth cohort, data linkage study to analyse the daily, weekly and yearly cycles of births and their implications for the NHS. Although Public Involvement and Engagement (PI&E), also referred to here as Patient and Public Involvement (PPI), has a long history in maternity services, PI&E in maternity data linkage studies is new. We have reported using the GRIPP2 short form.
ObjectivesWe aimed to involve and engage a wide range of maternity service users and their representatives to ensure that our use of routinely collected maternity and birth records was acceptable and that our research analyses using linked data were relevant to their expressed safety and quality of care needs.
MethodsA three-tiered approach to PPI was used. Having both PPI co-investigators and PPI members of the Study Advisory Group ensured service user involvement was part of the strategic development of the project. A larger constituency of maternity service users was engaged through four workshops held throughout England.
ResultsTwo co-investigators with experience of PPI in maternity research were involved from design stage to dissemination. Four PPI study advisors contributed service user perspectives. Engagement workshops attracted around 100 attendees, recruited largely from Maternity Services Liaison Committees and a community engagement group. They supported use of the data, believing the study had potential to improve safety and quality of maternity services. They contributed their experiences and concerns which will assist with interpretation of the analyses.
ConclusionUse of PPI 'knowledge intermediaries' successfully bridged the gap between data intensive research and lived experience, but more inclusivity in involvement and engagement is required. The concerns and questions of service users provide social legitimacy and a relevance framework for researchers carrying out analyses.

ObjectivesPotential 'weekend effects' in healthcare prompt concerns that care could be of lower quality during non-working hours, but may reflect differences in case mix or other factors This research aimed to compare neonatal mortality in English hospitals from 2005 to 2014 by time of day and day of the week.
ApproachWe analysed data from a retrospective cohort of 6,054,536 singleton births in England 2005—2014, created by linking ONS birth and death registration and birth notification data with Hospital Episode Statistics.
Working hours were defined as 07:00—19:00 on weekdays, and non-working hours were all other times on weekdays and all weekends and public holidays.
The primary outcome was all-cause neonatal mortality unattributed to congenital anomaly. We also modelled cause-specific neonatal mortality attributed to asphyxia, anoxia or trauma (AAT). On advice through our public involvement and strategy, analysis was stratified by mode of onset of labour and method of delivery.
ResultsAfter adjustment for confounders, the odds of all-cause neonatal mortality outside of working hours were similar to those during working hours for spontaneous births, instrumental births and emergency caesareans. Planned caesareans occurring in non-working hours had a high crude risk compared to planned caesareans in working hours, but were considered to be unreliably recorded and likely to reflect emergency caesarean delivery of babies originally scheduled for planned caesarean birth.
Further stratification of emergency caesareans by onset of labour showed higher odds of cause-specific neonatal mortality (AAT) during non-working compared with working hours for emergency caesareans without labour recorded but not for emergency caesareans after spontaneous or induced onset of labour.
ConclusionIt may be that the apparent 'weekend effect' is caused by deaths among the relatively small number of babies who were born by caesarean section apparently without labour outside normal working hours. Obstetric staffing should be planned to allow for these relatively unusual emergencies.

BACKGROUND: The setting in which induction of labour takes place (home or inpatient) is likely to have implications for safety, women's experiences and costs. Home induction may be started at home with the subsequent active phase of labour happening either at home or in a healthcare facility (hospital, birth centre, midwifery‐led unit). More commonly, home induction starts in a healthcare facility, then the woman goes home to await the start of labour. Inpatient induction takes place in a healthcare facility where the woman stays while awaiting the start of labour. OBJECTIVES: To assess the effects on neonatal and maternal outcomes of third trimester home induction of labour compared with inpatient induction using the same method of induction. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (31 January 2020)), and reference lists of retrieved studies. SELECTION CRITERIA: Published and unpublished randomised controlled trials (RCTs) in which home and inpatient settings for induction have been compared. We included conference abstracts but excluded quasi‐randomised trials and cross‐over studies. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently. GRADE assessments were checked by a third review author. MAIN RESULTS: We included seven RCTs, six of which provided data on 1610 women and their babies. Studies were undertaken between 1998 and 2015, and all were in high‐ or upper‐middle income countries. Most women were induced for post dates. Three studies reported government funding, one reported no funding and three did not report on their funding source. Most GRADE assessments gave very low‐certainty evidence, downgrading mostly for high risk of bias and serious imprecision. 1. Home compared to inpatient induction with vaginal ...

BackgroundUsing routinely collected clinical data for observational research is an increasingly important method for data collection, especially when rare outcomes are being explored. The POOL study was commissioned to evaluate the safety of waterbirth in the UK using routine maternity and neonatal clinical data. This paper describes the design, rationale, set-up and pilot for this data linkage study using bespoke methods.
MethodsClinical maternity information systems hold many data items of value for research purposes, but often lack specific data items required for individual studies. This study used the novel method of amending an existing clinical maternity database for the purpose of collecting additional research data fields. In combination with the extraction of existing data fields, this maximised the potential use of existing routinely collected clinical data for research purposes, whilst reducing NHS staff data collection burden.
Wellbeing Software® provider of the Euroking® Maternity Information System, added new study specific data fields to their information system, extracted data from participating NHS sites and transferred data for matching with the National Neonatal Research Database to ascertain outcomes for babies admitted to neonatal units. Study set-up processes were put in place for all sites. The data extraction, linkage and cleaning processes were piloted with one pre-selected NHS site.
ResultsTwenty-six NHS sites were set-up over 27 months (January 2019 - April 2021). Twenty-four thousand maternity records were extracted from the one NHS site, pertaining to the period January 2015 to March 2019. Data field completeness for maternal and neonatal primary outcomes were mostly acceptable. Neonatal identifiers flowed to the National Neonatal Research Database for successful matching and linkage between maternity and neonatal unit records.
DiscussionPiloting the data extraction and linkage highlighted the need for additional governance arrangements, training at NHS sites and new processes for the study team to ensure data quality and confidentiality are upheld during the study. Amending existing NHS electronic information systems and accessing clinical data at scale, is possible, but continues to be a time consuming and a technically challenging exercise.