Incidence of Neuralgic Amyotrophy (Parsonage Turner Syndrome) in a Primary Care Setting - A Prospective Cohort Study

BackgroundClinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.AimTo estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.Design and settingSecondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.MethodBaseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.ResultsSixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).ConclusionMost children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

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Immunisation coverage in the rural Eastern Cape – are we getting the basics of primary care right? Results from a longitudinal prospective cohort study

South African Medical Journal ◽

10.7196/samj.2017.v107i3.12400 ◽

2017 ◽

Vol 107 (3) ◽

pp. 274

Author(s):

C Naidu

Keyword(s):

Primary Care ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Eastern Cape ◽

Immunisation Coverage

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The effectiveness of varenicline versus nicotine replacement therapy on long-term smoking cessation in primary care: a prospective cohort study of electronic medical records

International Journal of Epidemiology ◽

10.1093/ije/dyx109 ◽

2017 ◽

Vol 46 (6) ◽

pp. 1948-1957 ◽

Cited By ~ 27

Author(s):

Gemma MJ Taylor ◽

Amy E Taylor ◽

Kyla H Thomas ◽

Timothy Jones ◽

Richard M Martin ◽

...

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Cohort Study ◽

Replacement Therapy ◽

Nicotine Replacement Therapy ◽

Electronic Medical Records ◽

Prospective Cohort Study ◽

Medical Records ◽

Prospective Cohort

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Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

BMJ Open ◽

10.1136/bmjopen-2021-053624 ◽

2021 ◽

Vol 11 (10) ◽

pp. e053624

Author(s):

Daniel Smith ◽

Kathryn Willan ◽

Stephanie L Prady ◽

Josie Dickerson ◽

Gillian Santorelli ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Mental Disorders ◽

Outcome Measures ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Common Mental Disorders ◽

Free Text ◽

Primary Care Data ◽

Time Point

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

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