scholarly journals International impact of large multi-centre surgical trials of arthroscopic subacromial decompression

2021 ◽  
Author(s):  
James Andrew Smith ◽  
Kristin Kostka ◽  
David J Beard ◽  
Andrew J Carr ◽  
Jonathan L Rees ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Temporal Trends ◽  
Practice Research ◽  
Sex Characteristics ◽  
Clinical Practice Research Datalink ◽  
Subacromial Decompression ◽  
Shoulder Impingement ◽  
The Uk ◽  
Arthroscopic Subacromial Decompression ◽  
Over Time

Objectives To examine temporal trends in incidence of arthroscopic subacromial decompression (ASAD) surgery internationally during conduct and after publication of placebo controlled trials finding no evidence of meaningful benefit of ASAD for shoulder impingement. Design Observational study of incidence rates. Setting Large routinely collected datasets were used: outpatient data from Belgium and UK, and insurance claims and outpatient data from US. UK data were from Clinical Practice Research Datalink and Belgium and US data were from IQVIA. US and UK data spanned 2005 - 2019 and Belgium data 2011 - 2019. Participants Patients were eligible for inclusion in the study if they had at least one visit recorded in the database in a given year and cases were defined as patients undergoing ASAD for the first time in their records in a given year. Outcome measures We calculated incidence of ASAD over time, overall and stratified by age and sex. Characteristics of patients undergoing ASAD were also assessed over time. Results UK incidence has fallen since a peak of 4.7 per 10,000 person years in 2011 (when the CSAW trial began) to 1.8 in 2019. US incidence shows no clear pattern and remains consistently higher than the UK, at 11.5 per 100,000 person years in 2019. Changes in incidence patterns were similar across different age groups and sexes. The number of cases in Belgium was too small for meaningful conclusions. Conclusions We found ASAD rates have fallen in the UK during conduct and after publication of two large surgical RCTs from the UK and Finland that questioned the effectiveness of ASAD for shoulder impingement. A similar impact on clinical practice has not been seen in US. Further work to understand the barriers or concerns preventing international uptake of high quality evidence into clinical practice is needed.

scholarly journals Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Head ◽  
K Fleming ◽  
C Kypridemos ◽  
P Schofield ◽  
M O'Flaherty
Keyword(s):  
Chronic Conditions ◽  
Large Population ◽  
Temporal Trends ◽  
Population Level ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
The Uk ◽  
Three Body ◽  
Over Time

Abstract Background An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence. Methods We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time. Results Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430). Conclusions The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends. Key messages The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.

scholarly journals Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD)

BMJ Open ◽  
2016 ◽  
Vol 6 (1) ◽  
pp. e009147 ◽  
Author(s):  
Lamiae Grimaldi-Bensouda ◽  
Olaf Klungel ◽  
Xavier Kurz ◽  
Mark C H de Groot ◽  
Ana S Maciel Afonso ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Risk Analysis ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Channel Blockers ◽  
The Uk

scholarly journals Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink

2018 ◽  
Vol 78 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Dahai Yu ◽  
Kelvin P Jordan ◽  
Kym I E Snell ◽  
Richard D Riley ◽  
John Bedson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Large Scale ◽  
Prediction Models ◽  
Cox Proportional Hazards ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Total Hip ◽  
Risk Of Death ◽  
Geographical Regions ◽  
The Uk

ObjectivesThe ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.MethodsWe identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.Results45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).ConclusionsTwo prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

scholarly journals Statin use and reduced risk of biliary tract cancers in the UK Clinical Practice Research Datalink

Gut ◽  
2018 ◽  
Vol 68 (8) ◽  
pp. 1458-1464 ◽  
Author(s):  
Zhiwei Liu ◽  
Rotana Alsaggaf ◽  
Katherine A McGlynn ◽  
Lesley A Anderson ◽  
Huei-Ting Tsai ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Biliary Tract ◽  
Conditional Logistic Regression ◽  
Incidence Density ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Biliary Tract Cancers ◽  
The Uk ◽  
Reduced Risk ◽  
Statin Use

ObjectiveTo evaluate the association between statin use and risk of biliary tract cancers (BTC).DesignThis is a nested case–control study conducted in the UK Clinical Practice Research Datalink. We included cases diagnosed with incident primary BTCs, including cancers of the gall bladder, bile duct (ie, both intrahepatic and extrahepatic cholangiocarcinoma), ampulla of Vater and mixed type, between 1990 and 2017. For each case, we selected five controls who did not develop BTCs at the time of case diagnosis, matched by sex, year of birth, calendar time and years of enrolment in the general practice using incidence density sampling. Exposures were defined as two or more prescription records of statins 1 year prior to BTC diagnosis or control selection. ORs and 95% CIs for associations between statins and BTC overall and by subtypes were estimated using conditional logistic regression, adjusted for relevant confounders.ResultsWe included 3118 BTC cases and 15 519 cancer-free controls. Current statin use versus non-use was associated with a reduced risk of all BTCs combined (adjusted OR=0.88, 95% CI 0.79 to 0.98). The reduced risks were most pronounced among long-term users, as indicated by increasing number of prescriptions (ptrend=0.016) and cumulative dose of statins (ptrend=0.008). The magnitude of association was similar for statin use and risk of individual types of BTCs. The reduced risk of BTCs associated with a record of current statin use versus non-use was more pronounced among persons with diabetes (adjusted OR=0.72, 95% CI 0.57 to 0.91). Among non-diabetics, the adjusted OR for current statin use versus non-use was 0.91 (95% CI 0.81 to 1.03, pheterogeneity=0.007).ConclusionCompared with non-use of statins, current statin use is associated with 12% lower risk of BTCs; no association found with former statin use. If replicated, particularly in countries with a high incidence of BTCs, our findings could pave the way for evaluating the value of statins for BTC chemoprevention.

scholarly journals Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink

2018 ◽  
Vol 28 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Rory J. Ferguson ◽  
Daniel Prieto‐Alhambra ◽  
Christine Walker ◽  
Dahai Yu ◽  
Jose M. Valderas ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

scholarly journals The incidence, prevalence, and survival of systemic sclerosis in the UK Clinical Practice Research Datalink

2018 ◽  
Vol 37 (8) ◽  
pp. 2103-2111 ◽  
Author(s):  
Jeremy G. Royle ◽  
Peter C. Lanyon ◽  
Matthew J. Grainge ◽  
Abhishek Abhishek ◽  
Fiona A. Pearce
Keyword(s):  
Clinical Practice ◽  
Systemic Sclerosis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk ◽  
Incidence Prevalence

scholarly journals Examining the risk of depression or self-harm associated with incretin-based therapies used to manage hyperglycaemia in patients with type 2 diabetes: a cohort study using the UK Clinical Practice Research Datalink

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023830 ◽  
Author(s):  
John-Michael Gamble ◽  
Eugene Chibrikov ◽  
William K Midodzi ◽  
Laurie K Twells ◽  
Sumit R Majumdar
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Population Based ◽  
Practice Research ◽  
Primary Study ◽  
Clinical Practice Research Datalink ◽  
Glucose Lowering ◽  
Self Harm ◽  
The Uk ◽  
New Onset

ObjectivesTo compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents.DesignPopulation-based cohort study.SettingPatients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD).ParticipantsUsing the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016. Patients with a prior history of depression, self-harm and other serious psychiatric conditions were excluded.Main outcome measuresThe primary study outcome comprised a composite of new-onset depression or self-harm. Unadjusted and adjusted Cox proportional hazards regression was used to quantify the association between incretin-based therapies and depression or self-harm. Deciles of High-Dimensional Propensity Scores and concurrent number of glucose-lowering agents were used to adjust for potential confounding.ResultsWe identified new users of 6206 DPP-4i and 22 128 SU in the DPP-4i-cohort, and 501 GLP-1RA and 16 409 SU new users in the GLP-1RA-cohort. The incidence of depression or self-harm was 8.2 vs 11.7 events/1000 person-years in the DPP-4i-cohort and 18.2 vs 13.6 events/1000 person-years in the GLP-1RA-cohort for incretin-based therapies versus SU, respectively. Incretin-based therapies were not associated with an increased or decreased incidence of depression or self-harm compared with SU (DPP-4i-cohort: unadjusted HR 0.70, 95% CI 0.51 to 0.96; adjusted HR 0.80, 95% CI 0.57 to 1.13; GLP-1RA-cohort: unadjusted HR 1.36, 95% CI 0.72 to 2.58; adjusted HR 1.25, 95% CI 0.63 to 2.50). Consistent results were observed for other glucose-lowering comparators including insulin and thiazolidinediones.ConclusionsOur findings suggest that the two incretin-based therapies are not associated with an increased or decreased risk of depression or self-harm.

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