scholarly journals Clinical importance of the drug interaction between statins and CYP3A4 inhibitors: a retrospective cohort study in The Health Improvement Network

2012 ◽  
Vol 21 (5) ◽  
pp. 494-506 ◽  
Author(s):  
Christopher G. Rowan ◽  
Steven M. Brunelli ◽  
Jeffrey Munson ◽  
James Flory ◽  
Peter P. Reese ◽  
...  
Keyword(s):  
Cohort Study ◽  
Drug Interaction ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Importance ◽  
Health Improvement ◽  
Cyp3a4 Inhibitors ◽  
The Health Improvement Network

scholarly journals Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026714 ◽  
Author(s):  
Philip R Harvey ◽  
Tom Thomas ◽  
Joht Singh Chandan ◽  
Neeraj Bhala ◽  
Krishnarajah Nirantharakumar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Learning Disability ◽  
Incidence Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
History Of ◽  
Study Population ◽  
The Health Improvement Network

ObjectivesTo measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI.DesignRetrospective cohort study.Setting and participantsThe study population included patients with LD undergoing FG placement in the ‘The Health Improvement Network’ database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel.Main outcome measuresIncidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI.Results214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05).ConclusionIn LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.

scholarly journals Faecal calprotectin testing in UK general practice: a retrospective cohort study using The Health Improvement Network database

2021 ◽  
pp. BJGP.2021.0125
Author(s):  
Karoline Freeman ◽  
Ronan Ryan ◽  
Nicholas Parsons ◽  
Sian Taylor-Phillips ◽  
Brian H Willis ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Electronic Patient Records ◽  
Faecal Calprotectin ◽  
Network Database ◽  
Number Of Patients ◽  
The Health Improvement Network

BackgroundFaecal calprotectin (FC) testing to detect inflammatory bowel disease (IBD) was recommended for use in UK general practice in 2013. The actual use of FC testing following the national recommendations is unknown.AimTo characterise the use of FC testing for IBD in UK general practice.Design and settingA retrospective cohort study of routine electronic patient records from The Health Improvement Network database from UK general practice.MethodThe study included 6 965 853 adult patients (aged ≥18 years), between 2006 and 2016. FC test uptake, the patients tested, and patient management following testing were characterised.ResultsA total of 17 027 patients had 19 840 FC tests recorded. The mean age of tested patients was 44.2 years. The first FC tests were documented in 2009. FC test use was still increasing in 2016. By 2016, 66.8% (n = 493/738) of practices had started FC testing. About one-fifth (20.7%, n = 1253/6051) of tests were carried out in patients aged ≥60 years. Only 7.8% (n = 473/6051) of the FC test records were preceded by symptoms eligible for FC testing. Only 3.1% (n = 1720/55 477) of patients with eligible symptoms have received FC testing since the national recommendations were published. There was only a small number of patients with symptoms, FC test, and a IBD diagnosis. In total, 71.3% (n = 1416/1987) of patients with a positive and 47.7% (n = 1337/2805) with a negative FC test were referred or further investigated.ConclusionUptake of FC testing in clinical practice has been slow and inconsistent. The indication of non-compliance with national recommendations may suggest that these recommendations lack applicability to the general practice context.

Cancer as a risk factor for urinary tract calculi: a retrospective cohort study using ‘The Health Improvement Network’

Urolithiasis ◽  
2019 ◽  
Vol 47 (6) ◽  
pp. 541-547
Author(s):  
Ankush Mittal ◽  
Motaz Elmahdy Hassan ◽  
Joht Singh Chandan ◽  
Brian H. Willis ◽  
Krishnarajah Nirantharakumar ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Urinary Tract ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Urinary Tract Calculi ◽  
The Health Improvement Network

scholarly journals Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study

2017 ◽  
Vol 67 (657) ◽  
pp. e300-e305 ◽  
Author(s):  
Lavanya Diwakar ◽  
Carole Cummins ◽  
Ronan Ryan ◽  
Tom Marshall ◽  
Tracy Roberts
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Number Of Children ◽  
Prescription Rates ◽  
The Uk ◽  
Primary Care Practices

BackgroundAdrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.Aim To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.Design and setting Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.MethodChildren and young people aged between 0–17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).ResultsA total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.ConclusionThe number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.

scholarly journals Clinically relevant QTc prolongation due to overridden drug-drug interaction alerts: a retrospective cohort study

2009 ◽  
Vol 67 (3) ◽  
pp. 347-354 ◽  
Author(s):  
Heleen van der Sijs ◽  
Ravi Kowlesar ◽  
A. Peter J. Klootwijk ◽  
Stefan P. Nelwan ◽  
Arnold G. Vulto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Drug Interaction ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Qtc Prolongation ◽  
Drug Drug Interaction

Potential interaction between acenocoumarol and diclofenac, naproxen and ibuprofen and role of CYP2C9 genotype

2004 ◽  
Vol 91 (01) ◽  
pp. 95-101 ◽  
Author(s):  
Arian Plat ◽  
Alieke van Dijk ◽  
Margriet Piersma-Wichers ◽  
Anne de Vries-Bots ◽  
Jennita Slomp ◽  
...  
Keyword(s):  
Cohort Study ◽  
Drug Interaction ◽  
Therapeutic Range ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Reports ◽  
Cyp2c9 Genotype ◽  
Range Type ◽  
Drug Drug Interaction

SummaryNSAIDs are reported to increase the risk of bleeding in coumarin users. The mechanism underlying this risk is inhibition of platelet aggregation, however a pharmacokinetic mechanism resulting in an increased International Normalised Ratio (INR) was proposed in some case reports in warfarin treated patients. In this retrospective cohort study the influence of diclofenac, naproxen and ibuprofen on the INR of outpatients stabilised on acenocoumarol therapy was investigated. We also determined the role of cytochrome P450 2C9 (CYP2C9) polymorphism on coumarin dosage and INR in NSAID users. The study was carried out at the Groningen Outpatient Thrombosis Service. A retrospective cohort study among patients who received both acenocoumarol and one of the NSAIDs under study was performed. Patients whose INR rose above the upper level of the therapeutic range (INR above 3.5 or 4.0) after an NSAID under study was added to the acenocoumarol therapy, were compared with patients who did not show such an elevation. A two-sample t-test (average acenocoumarol dosage, age), and chi-square tests (sex, therapeutic range, type of NSAID) were used to test for differences. Genotyping was carried out by analysing blood samples for the relevant CYP2C9 alleles. The study population consisted of 112 patients on stable acenocoumarol therapy, of which 52 (46%) showed an elevation of the INR above the desired therapeutic level (INR3.5 and 4.0 respectively) after the start of an NSAID under study. In 12 patients, the INR increased above 6. The INR of the other 60 patients (54%) remained constant after the start of one of the NSAIDs under study. There were no statistically significant differences between patients with increased INR and patients without increased INR with regard to age, sex, therapeutic range and average acenocoumarol dosage. Eighty patients, of whom 36 showed an increased INR as a result of a potential acenocoumarol-NSAID drug interaction, were included in the genotyping study. No association between CYP2C9 genotype and an increased INR as a result of the drug-drug interaction was found. In nearly half of a cohort of elderly patients, the INR increased beyond the therapeutic range (INR 3.5 or 4.0) as a result of a potential pharmacokinetic drug-drug interaction between acenocoumarol and diclofenac, naproxen and ibuprofen. The average increase in INR was between 1 and 4. Polymorphism of CYP2C9 does not seem to be a relevant risk factor for the NSAID-acenocoumarol interaction.

scholarly journals Seizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN database

2019 ◽  
Vol 104 (11) ◽  
pp. 1070-1076 ◽  
Author(s):  
Melissa Myland ◽  
Brian Buysse ◽  
Wan Tsong ◽  
G Sarah Power ◽  
Douglas Nordli ◽  
...  
Keyword(s):  
Cohort Study ◽  
Seizure Frequency ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Negative Binomial ◽  
Healthcare Resource ◽  
Cox Proportional Hazards ◽  
Resource Utilisation ◽  
Health Improvement ◽  
Healthcare Resource Utilisation

ObjectiveTo understand the association of seizure frequency with healthcare resource utilisation (HCRU) and mortality in UK children with epilepsy (CWE).DesignRetrospective cohort study.SettingRoutinely collected data in primary care from The Health Improvement Network UK database.PatientsCWE ≥1 and<18 years of age with a record of seizure frequency were included in mortality analyses from 2005 to 2015 and HCRU analyses from 2010 to 2015.Main outcome measuresFrequency of HCRU contacts during the year following latest seizure frequency and mortality (descriptive and Cox proportional hazards regression) from first record of seizure frequency.ResultsHigher seizure frequency was related to increased HCRU utilisation and mortality. In negative binomial regression, each category increase in seizure frequency related to 11% more visits to general practitioners, 35% more inpatient admissions, 15% more outpatient visits and increased direct HCRU costs (24%). 11 patients died during 12 490 patient-years follow-up. The unadjusted HR of mortality per higher category of seizure frequency was 2.56 (95% CI: 1.52 to 4.31). Adjustment for age and number of prescribed anti-epileptic drugs at index attenuated this estimate to 2.11 (95% CI: 1.24 to 3.60).ConclusionHigher seizure frequency is associated with greater HCRU and mortality in CWE in the UK. Improvement in seizure control may potentially lead to better patient outcomes and reduced healthcare use.

Sign in / Sign up

Export Citation Format

Share Document