scholarly journals Trends in antiepileptic drug treatment and effectiveness in clinical practice in England from 2003 to 2016: a retrospective cohort study using electronic medical records

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032551 ◽  
Author(s):  
Graham Powell ◽  
John Logan ◽  
Victor Kiri ◽  
Simon Borghs
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Electronic Medical Records ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Retrospective Cohort ◽  
First Line ◽  
Nice Guideline ◽  
Treatment Trends ◽  
Over Time

ObjectiveTo assess the evolution of antiepileptic drug (AED) treatment patterns and seizure outcomes in England from 2003 to 2016.Design, setting and participantsRetrospective cohort study of electronic medical records from Clinical Practice Research Datalink and National Health Service Digital Hospital Episode Statistics databases. Patients newly diagnosed with epilepsy were identified and followed until end of data availability. Three eras were defined starting 1 April 2003 (first National Institute for Health and Care Excellence (NICE) guideline); 1 September 2007 (Standard and New Antiepileptic Drugs publication); and 1 January 2012 (second NICE guideline).Outcome measuresTime from diagnosis to first AED; AED sequence; time from first AED to first 1-year remission period (no new AED attempts and no seizure-related healthcare events); time from first AED to refractoriness (third AED attempt regardless of reason); Kaplan-Meier analysis of time-to-event variables.Results4388 patients were included (mean follow-up: 6.8, 4.2 and 1.7 years by era). 84.6% of adults (≥16 years), 75.5% of children (<16) and 89.1% of elderly subgroup (65+) received treatment within 1 year; rates were generally stable over time. Treatment trends included reduced use of carbamazepine (adult first line, era 1: 34.9%; era 3: 10.7%) and phenytoin, earlier line and increased use of levetiracetam (adult first line, era 1: 2.6%; era 3: 26.2%) and lamotrigine (particularly in adults and elderly subgroup), and a larger number of different AEDs used. Valproate use shifted somewhat to later lines. Rates of 1-year remission within 2 years of starting treatment increased in adults (era 1: 71.9%; era 3: 81.4%) and elderly (era 1: 76.1%; era 3: 81.7%). Overall, 55.5% of patients relapsed after achieving 1-year remission. Refractoriness rates remained stable over time (~26% of adults within 5 years).ConclusionTreatment trends often were not aligned with era-relevant guidance. However, our results suggest a slight improvement in epilepsy treatment outcomes over the 13-year period.

scholarly journals Strategies for the Prevention of the Intra-Hospital Transmission of COVID-19: A Retrospective Cohort Study

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 195 ◽  
Author(s):  
Min Cheol Chang ◽  
Jian Hur ◽  
Donghwi Park
Keyword(s):  
Cohort Study ◽  
Electronic Medical Records ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Hospital Staff ◽  
University Hospital ◽  
Actual Situation ◽  
Recommended Guidelines ◽  
Hospital Transmission

Coronavirus disease (COVID-19) has spread rapidly worldwide. We aimed to review the strategies used by our university hospital in Daegu (South Korea) to prevent the transmission of COVID-19 within our institution. We also investigated the actual situation at our hospital against the recommended guidelines. We conducted a survey among patients and staff in our hospital. Additionally, patients’ electronic medical records were reviewed along with closed-circuit television (CCTV) recordings. Various strategies and guidelines developed by our hospital have been implemented. A total of 303 hospital staff and patients had exposure to 29 confirmed COVID-19 patients. Of them, three tested positive for COVID-19 without further transmission. The intra-hospital infection of the disease occurred when the recommended strategies and guidelines such as wearing a mask and isolating for 2 weeks were not followed. In conclusion, the implementation of robust guidelines for preventing the intra-hospital transmission of COVID-19 is essential.

scholarly journals Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

2018 ◽  
Vol 69 (678) ◽  
pp. e33-e41 ◽  
Author(s):  
Dana Šumilo ◽  
Linda Nichols ◽  
Ronan Ryan ◽  
Tom Marshall
Keyword(s):  
Cohort Study ◽  
Electronic Medical Records ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Periodic Fever ◽  
Sleep Apnoea ◽  
Evidence Based ◽  
Research Database ◽  
Obstructive Sleep

BackgroundNeither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.AimTo determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.Design and settingA retrospective cohort study of electronic medical records of children aged 0–15 years registered with 739 UK general practices contributing to a research database.MethodChildren with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined.ResultsThe authors included 1 630 807 children followed up for 7 200 159 person–years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%).ConclusionIn the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.

Real World Use and Effects of Calcimimetics in Treating Mineral and Bone Disorder in Hemodialysis Patients

2020 ◽  
Vol 51 (10) ◽  
pp. 815-822
Author(s):  
Mark D. Danese ◽  
Deborah Lubeck ◽  
Vasily Belozeroff ◽  
Tzu-Chieh Lin ◽  
Pooja Desai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Index Date ◽  
Hemodialysis Patients ◽  
Mineral And Bone Disorder ◽  
Kaplan Meier ◽  
Bone Disorder ◽  
Over Time

<b><i>Background:</i></b> Calcimimetics are used to treat mineral and bone disorder by reducing parathyroid hormone (PTH), calcium (Ca), and phosphorus (Phos). The study objectives were to assess the control of PTH, Ca, and Phos over time in patients receiving cinacalcet or etelcalcetide as well as dosing and time to discontinuation for etelcalcetide. <b><i>Methods:</i></b> This was a retrospective cohort study using electronic medical records from small and independent dialysis centers. Adults ≥18 years of age were identified as cinacalcet or etelcalcetide users based on the first calcimimetic received in 2018 (index date). Patients were followed from the index date until parathyroidectomy, kidney transplant, death, or end of data (December 31, 2018). Analyses of mean PTH, Ca, and Phos, as well as target achievement of PTH, Ca, and Phos were conducted over a 9-month period. Discontinuation with etelcalcetide was measured with the Kaplan-Meier estimator. <b><i>Results:</i></b> There were 1,346 cinacalcet patients (mean age 60.5 years, 43.5% female, and 47.1% Black) and 1,255 etelcalcetide patients (mean age 63.4 years, 46.6% female, and 38.5% Black). At baseline, the proportions in target were similar for etelcalcetide versus cinacalcet: 36 versus 38% for PTH, 79 versus 80% for Ca, and 43 versus 44% for Phos. Overall, 40–47% of cinacalcet users and 48–62% of etelcalcetide users were observed to be in target for PTH over 9 months. The proportion in target for Phos ranged from 41 to 46% for cinacalcet and 46–51% for etelcalcetide. The proportion in target for Ca ranged from 74 to 78% for cinacalcet and 60–73% for etelcalcetide. Etelcalcetide 12-month discontinuation was 37.4%. <b><i>Conclusion:</i></b> Both calcimimetics were effective in keeping PTH, Ca, and Phos levels within target. Patients receiving etelcalcetide tended to have lower laboratory values for PTH, Ca, and Phos over time, while patients receiving cinacalcet tended to be more likely to be in target for Ca over time.

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